Amornyotin Somchai, Santawat Ubolrat, Rachatamukayanant Pranee, Nilsuwankosit Passaporn, Pipatnaraphong Hatairat
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
J Med Assoc Thai. 2002 Sep;85 Suppl 3:S969-74.
This study was undertaken to determine the effect of lidocaine pretreatment on reduction of succinylcholine-induced myalgia in patients undergoing general anesthesia for gynecological surgery. One hundred and thirty-five patients were assigned to one of three groups in a prospective, double blind, randomized manner. Group PS, the control group, received normal saline and succinylcholine 1.5 mg x kg(-1); Group LS, lidocaine 1.5 mg x kg(-1) and succinylcholine 1.5 mg x kg(-1); Group PR, normal saline and rocuronium 0.6 mg x kg(-1). Morphine 0.1 mg x kg(-1) iv was given for premedication and all patients were monitored with a noninvasive blood pressure monitor, ECG and pulse oximetry. Anesthesia was induced with 5 mg.kg(-1) thiopental iv. followed by succinylcholine (Group PS, LS) or rocuronium (Group PR) for tracheal intubation. Following administration of these agents, the presence, and degree of fasciculation were assessed visually on a four point scale by one investigator who was blinded to the drug administered. The blood pressure and heart rate of each patient were monitored on nine occasions. Twenty-four hours later, any myalgia experienced was assessed according to a structured questionaire and graded by a four point scale by one investigator blinded to the intraoperative management. The results indicate that muscle fasciculation was not found in Group PR while the patients in Group LS had a lower incidence of muscle fasciculation than those in Group PS (p < 0.001). At 24 h, the incidence of myalgia was higher in Group PS than in Group LS and PR (p < 0.05). A correlation was not found between the incidence of myalgia and the occurrence of muscle fasciculation. The changes in systolic and diastolic blood pressure and heart rate were not significant among the three groups. In conclusion, where succinylcholine is used, lidocaine is proven to be the useful pretreatment agent for the reduction of postoperative myalgia.
本研究旨在确定利多卡因预处理对接受妇科手术全身麻醉患者琥珀酰胆碱诱导的肌痛减轻的影响。135例患者以前瞻性、双盲、随机的方式被分配到三组中的一组。PS组为对照组，接受生理盐水和1.5mg/kg（-1）琥珀酰胆碱；LS组，1.5mg/kg（-1）利多卡因和1.5mg/kg（-1）琥珀酰胆碱；PR组，生理盐水和0.6mg/kg（-1）罗库溴铵。静脉注射0.1mg/kg（-1）吗啡进行术前用药，所有患者均使用无创血压监测仪、心电图和脉搏血氧饱和度仪进行监测。静脉注射5mg/kg（-1）硫喷妥钠诱导麻醉。随后给予琥珀酰胆碱（PS组、LS组）或罗库溴铵（PR组）进行气管插管。给予这些药物后，由一名对所给药不知情的研究者以四点量表直观评估肌束颤动的存在及程度。对每位患者的血压和心率进行9次监测。24小时后，根据结构化问卷评估所经历的任何肌痛，并由一名对术中管理不知情的研究者以四点量表进行分级。结果表明，PR组未发现肌束颤动，而LS组患者肌束颤动的发生率低于PS组（p<0.001）。在24小时时，PS组肌痛的发生率高于LS组和PR组（p<0.05）。未发现肌痛发生率与肌束颤动的发生之间存在相关性。三组间收缩压、舒张压和心率的变化无显著性差异。总之，在使用琥珀酰胆碱的情况下，利多卡因被证明是减轻术后肌痛的有效预处理药物。
