Comparisonoftwodosesofpregabalinfor Preventingsuccinylcholineinducedfasciculations Andmyalgiainpatientsundergoingsurgeryunder Generalanaesthesia:Arandomisedcontrolled Study

Abstract

AIM To compare the efficacy of two doses of Pregabalin for preventing succinylcholine induced fasciculations and myalgia. BACKGROUND Succinylcholine is the most commonly used muscle relaxant during endotracheal intubation in patients undergoing surgery under GA due to its rapid onset of action and shorter duration of action.It has been known to cause side effects, of which most commonly encountered are fasciculations and postoperative myalgia.Many drugs, such as magnesium sulphate, benzodiazepines, phenytoin, ketorolac, diclofenac, etc., have been studied to prevent postoperative myalgia and fasciculations.Gabapentin, an analog of Pregabalin, have been studied to prevent fasciculations and postoperative myalgia but requires a a larger dose of the drug to produce significant results. Compared to gabapentin, Pregabalin is known to be more effective even at a lower dose, thereby decreasing side effects. But similar studies are done less using Pregabalin.Pregabalin is a structural analogue of neurotransmitter GABA and is an α2δ calcium channel antagonist which inhibits presynaptic neurotransmitter release like glutamate and substance P. MATERIALSANDMETHODS This study was carried out on patients undergoing Surgery under General Anaesthesia in B.L.D.E. DU's Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura. Study Design: Prospective randomized, double blind Study, Study Period: One and a half year, Sample Size: 201 patients of both genders are randomly divided into three groups of 67 each as:- Group A : Cap Pregabalin 75mg, Group B : Cap Pregabalin 150mg, Group C : Saccharine pill 10mg 2 hours prior to surgery. RESULTS Both incidence and severity of fasciculations and myalgia was reduced in patients who received pregabalin compared to placebo group (Group B>A>C). It was observed that as severity of fasciculations increased, severity of myalgia also increased. Time of 1st analgesic dose was prolonged in pregabalin group (Group B>A>C). Attenuation of pressor response and hemodynamic stability was more in pregabalin group (Group B>A>C). Sedation levels were insignificant among groups. Incidence of adverse effects were also insignificant among groups. CONCLUSION We conclude that preoperative prophylactic administration of oral pregabalin at 75 mg and 150 mg reduced incidence and severity of succinylcholine induced fasciculations and myalgia. A dose of 150 mg was found to be more effective than 75 mg. Side effects were not significant at a dose of 150 mg. Pressor response attenuation was found to be more effective at a dose of 150 mgcompared to 75 mg. Hemodynamic stability was maintained at both pregabalin doses . Hence it is concluded that preoperative oral Pregabalin is an effective and safe method for prevention of Succinylcholine induced fasciculations and myalgia