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

Abstract

Introduction: 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 endotrachealintubation 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.