A COMPARATIVE STUDY OF MUSCLE FASCICULATION AND POSTOPERATIVE MYALGIA FOLLOWING ENDOTRACHEAL INTUBATION USING VECURONIUM BROMIDE VS SUCCINYLCHOLINE WITH OR WITHOUT ROCURONIUM PRIMING: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

Abstract

ntroduction:
Endotracheal intubation commonly requires neuromuscular blockade for optimal intubating
conditions. Succinylcholine remains the gold standard because of its rapid onset and short
duration but is associated with muscle fasciculations and postoperative myalgia. Rocuronium
pretreatment has been proposed to reduce these adverse effects.
Objective:
To compare the incidence of fasciculation and postoperative myalgia following endotracheal intubation using succinylcholine alone, succinylcholine with rocuronium priming, and
vecuronium alone.
Methods:
This prospective randomized controlled trial included 75 patients of American Society of
Anaesthesiologists (ASA) physical status I–II, aged 18–60 years, undergoing elective surgery
under general anaesthesia. Patients were randomly allocated into three groups (n=25 each):
Group S received succinylcholine 1.5 mg/kg, Group SR received rocuronium priming 0.05 mg/kg
followed by succinylcholine 1.5 mg/kg, and Group V received vecuronium 0.1 mg/kg. Primary
outcomes were incidence and severity of fasciculations and postoperative myalgia at 6, 12, and
24 hours. Secondary outcomes included intubating conditions and hemodynamic parameters.
Results:
Rocuronium priming significantly reduced fasciculations compared with succinylcholine alone
(32.0% vs 60.0%, p=0.013). Fasciculation-like movements were lowest in the vecuronium group
(16.0%). Intubating conditions differed significantly among groups, with the best conditions
observed in the rocuronium-primed group (p=0.048). Although postoperative myalgia was
numerically lower in the rocuronium-primed group, differences at 6, 12, and 24 hours were not
statistically significant (p>0.05). Hemodynamic parameters remained clinically acceptable in all
groups.
Conclusion:
Rocuronium priming significantly reduces succinylcholine-induced fasciculations and improves
intubating conditions. Although postoperative myalgia was numerically lower with rocuronium
priming, this difference did not reach statistical significance.