Source: Mencke et al. Anesth Analg 2002; 94: 573-6.

Reviewer:  R. Prasad, MD

Summary:

• 40 x 3 groups, ASA-PS I-II for ambulatory knee scope under standardized GA (midaz, fent, thiopentone; diclofenac PR; remi gtt and desflurane; metamizol and piritramid at end of surgery)
• A - Rocuronium 0.06mg/kg then Succ 1.5mg/kg
• B - NS then succ
• C - Saline then Roc 0.6mg/kg
• Blinded investigator rated:
• fasciculations (0-3)
• muscle weakness after pre-tx (# of sx mentioned, 0-5: diplopia, heavy eyelids, voice change, difficulty swallowing, dyspnea)
• incidence of bradycardia, dysrhythmia
• severity of postop myalgia (POM) at 1h and 24h postop
• Similar demographics in 3 groups
• Pretreatment
• worked to prevent succ-fasciculations
• caused sx of muscle weakness: A-90%, B-22.5%, C-15%
• usually low severity, i.e. 1-2 sx
• may have been some confusion in interpreting sx from sedation as muscle weakness (even B reported some weakness!)
• NO DIFFERENCE in POM among groups
• overall incidences: A-25%, B-30%, C-17.5%
• some (5-10%) reported in PACU, but more often at 24h follow-up

• very interesting - additional evidence that POM is multifactorial
• wonder if POM incidence is different with different pretreatments? Is d-TC the "gold standard?" Of course, it's no longer available...