Raman S K, San W M
Department of Anaesthesia, Tan Tock Seng Hospital, Singapore.
Can J Anaesth. 1997 May;44(5 Pt 1):498-502. doi: 10.1007/BF03011938.
To determine the attenuation in the incidence of myalgia, fasciculations and changes in serum potassium and creatinine kinase concentrations when atracurium and lidocaine were used in combination and separately as pretreatment before succinylcholine.
In a prospective, double blind randomized study, 80 ASA 1 patients 20-50 yr were assigned to one of four groups. Anaesthesia was induced with thiopentone and fentanyl. Group C received placebo pretreatment before 1.5 mg.kg-1 succinylcholine; Group A 0.05 mg.kg-1 atracurium three minutes before; Group L, 1.5 mg.kg-1 lidocaine 30 sec before; and group AL both atracurium and lidocaine. Serum potassium five minutes after succinylcholine, and creatinine kinase 24 hr after operation were measured and the increases from preinduction values were compared. Fasciculations and postoperative myalgia at 24 and 48 hr were recorded. Patients received iv meperidine or po paracetamol for postoperative analgesia.
The increase in serum potassium concentration (0.36 +/- 0.23 mEq.l-1) was not attenuated by any regimen (P < 0.05). The incidence of fasciculations (P < 0.05) and the increase in creatinine kinase (P < 0.01) was less in the atracurium (40%; 20.93 IU.l-1) and atracurium-lidocaine (30%; 22.85 IU.l-1) than in the lidocaine (85%; 45.01 IU.l-1) and control (100%; 56.5 IU.l-1) groups. Postoperative myalgia on Days 1 and 2 was lowest (P < 0.05) in the atracurium-lidocaine group (5%; 0%) followed by the atracurium (35%; 25%) and lidocaine (30%; 35%) groups and highest in the control (75%; 65%).
Atracurium and lidocaine individually reduce postoperative myalgia, with further decrease occurring when used together.
确定在琥珀酰胆碱使用前，阿曲库铵和利多卡因联合及单独用作预处理时，肌痛、肌束震颤的发生率以及血清钾和肌酸激酶浓度变化的衰减情况。
在一项前瞻性、双盲随机研究中，将80例年龄在20至50岁的ASA 1级患者分为四组。用硫喷妥钠和芬太尼诱导麻醉。C组在给予1.5mg·kg⁻¹琥珀酰胆碱前接受安慰剂预处理；A组在三分钟前给予0.05mg·kg⁻¹阿曲库铵；L组在30秒前给予1.5mg·kg⁻¹利多卡因；AL组同时给予阿曲库铵和利多卡因。测量琥珀酰胆碱给药五分钟后的血清钾以及术后24小时的肌酸激酶，并比较与诱导前值的增加情况。记录24小时和48小时时的肌束震颤和术后肌痛。患者术后接受静脉注射哌替啶或口服对乙酰氨基酚进行镇痛。
任何方案均未使血清钾浓度的升高（0.36±0.23mEq·l⁻¹）减弱（P<0.05）。阿曲库铵组（40%；20.93IU·l⁻¹）和阿曲库铵-利多卡因组（30%；22.85IU·l⁻¹）的肌束震颤发生率（P<0.05）和肌酸激酶升高幅度（P<0.01）低于利多卡因组（85%；45.01IU·l⁻¹）和对照组（100%；56.5IU·l⁻¹）。术后第1天和第2天的肌痛在阿曲库铵-利多卡因组最低（P<0.05）（5%；0%），其次是阿曲库铵组（35%；25%）和利多卡因组（30%；35%），对照组最高（75%；65%）。
阿曲库铵和利多卡因单独使用均可减轻术后肌痛，联合使用时减轻效果更明显。
