Prevention of succinylcholine myalgias: a meta-analysis

Meta-analysis is a term used to describe statistical methods for evaluating a series of research reports; this analysis transcends the limitations that may be inherent in each of the individual studies summarized. Forty-five research reports of clinical trials for the prevention of myalgias after succinylcholine were assembled. Four classes of preventive drugs (nondepolarizing muscle relaxants, benzodiazepines, succinylcholine in "self-taming" doses, and local anesthetics) were reported in detail sufficient to allow for inclusion in a meta-analysis of clinical efficacy. Each study was summarized by determining the difference in the incidence of myalgias on the first postoperative day between treatment and control groups. A random-effects variance components approach was used. Seven meta-analyses were performed (atracurium, d-tubocurarine, gallamine, pancuronium, diazepam, succinylcholine in self-taming doses, and lidocaine). For each meta-analysis there was statistically significant heterogeneity among studies. Atracurium, d-tubocurarine, gallamine, pancuronium, diazepam, and lidocaine all significantly decreased the frequency of myalgias by about 30%. Succinylcholine in self-taming doses alone was not efficacious.