Gabapentina; prevención de fasciculaciones y mialgias por succinilcolina

Uso profiláctico de gabapentina en la prevención de fasciculaciones y mialgias inducidas por succinilcolina: estudio randomizado, doble ciego y controlado con placebo Prophylactic use of gabapentin for prevention of succinylcholine-induced fasciculation and myalgia: A randomized, double-blinded, placebo-controlled study. Pandey CK, Tripathi M, Joshi G, Karna ST, Singh N, Singh PK. J Postgrad Med [serial online] 2012 [cited 2012 Feb 28];58:19-22. Background: Succinylcholine is used for rapid-sequence induction of anesthesia. Fasciculations and myalgia are adverse effects. The pretreatment modalities prevent or minimize its adverse effects. Aims: The present study is designed to evaluate the efficacy of gabapentin on the incidence of fasciculation and succinylcholine-induced myalgia. Settings and Design: The study was conducted at a tertiary care teaching hospital in a randomized, double-blinded, placebo-controlled manner. Materials and Methods: Patients of both genders undergoing laparoscopic cholecystectomy were randomly assigned to two groups. Patients in Group I (Gabapentin group) received 600 mg of gabapentin orally 2 h prior to surgery and patients in Group II (placebo group) received matching placebo. Anesthesia was induced with fentanyl 3 μg/kg, thiopentone 3-5 mg/kg and succinylcholine 1.5 mg/kg. All patients were observed and graded for fasciculations by a blinded observer and patients were intubated. Anesthesia was maintained with oxygen in air, sevoflurane and intermittent vecuronium bromide. After completion of surgery, neuromuscular blockade was reversed. A blinded observer recorded myalgia grade at 24 h. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. Statistical analysis: Demographic data, fasciculation grade, fentanyl consumption, and myalgia grade were compared using student t test and test of proportions. Results: The study included 76 American Society of Anesthesiologists' Grade I or II patients of either gender undergoing laparoscopic cholecystectomy. But only 70 patients completed the study. Results demonstrated that the prophylactic use of gabapentin significantly decreases the incidence and the severity of myalgia (20/35 vs. 11/35) (P<0.05) and decreases fentanyl consumption significantly in the study group (620+164 μg vs. 989+238 μg) (P<0.05) without any effects on the incidence and severity of fasciculations. Conclusions: Prophylactic use of gabapentin 600 mg in laparoscopic cholecystectomy decreases the incidence and severity of myalgia and fentanyl consumption. http://www.jpgmonline.com/text.asp?2012/58/1/19/93248  Gabapentina en la prevención de las fasciculaciones y mialgias inducidas por succinilcolina Gabapentin use in the prevention of succinylcholine-induced fasciculation and myalgia. Rayhill ML, Perloff MD.  J Postgrad Med [serial online] 2012 [cited 2012 Mar 8];58:1-2. Prophylactic use of gabapentin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo controlled study by Pandey CK et al.,[1] suggests gabapentin as a possible preventative therapeutic option for postoperative succinylcholine adverse reactions. Gabapentin has an ideal safety profile and is very well tolerated-especially given a single dose of 600 mg used in the study. We present some points of consideration that may affect the study's application to postoperative care. Although myalgia and fasciculation have clearly been associated with succinylcholine administration, [2],[3] the side-effect of myalgia is less specific to the drug. Therefore, it may be more challenging to determine how gabapentin affects postoperative myalgia specifically caused by succinylcholine. In the United States, between 75-80% of patients report postoperative pain. [4] The incidence of postoperative pain varies greatly depending on the nature of the procedure and patient-related factors. Postoperative pain is likely multi-factorial and separating myalgia ("muscle pain not related to surgical intervention") from surgical pain would seem a difficult distinction. More so, differentiating succinylcholine-induced postoperative myalgia from multi-factorial postoperative myalgia (surgical positioning, stasis, baseline disease, etc.) would seem even more difficult to achieve http://www.jpgmonline.com/text.asp?2012/58/1/1/93244

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org