
Anesthesia
Anesthesia and Muscle Pain
After surgery the incision is sometimes not the only area of discomfort.
Discomfort can occur in relation to nausea and vomiting, sore throat,
or muscle pains. You may experience an everyday sort of discomfort in
the neck, shoulders, back, or chest that comes from lying for a
prolonged time on an operating table designed not for comfort but for
stability, durability and access. Perhaps surprisingly, muscle pain can
also be a result of a particular drug used during anesthesia.
Postoperative Muscle Pain (Myalgia)
Severe muscle and joint discomfort that may be experienced after
surgery is known as postoperative muscle pain (myalgia). This is a
fairly common, quite distressing, but rather interesting condition. It
usually appears on the first day after surgery, is often described as
feeling similar to the pain one might suffer after unaccustomed physical
exercise, and is usually located in the neck, shoulder and upper
abdominal muscles.
There are a few theories about the cause of postoperative myalgia,
but it is usually attributed to the use of a muscle relaxant drug called
succinylcholine. Hence this is sometimes referred to as "scoline pain".
Succinylcholine and Scoline
If the muscle relaxant succinylcholine, also known as scoline, has
been used during anesthesia, this may in some patients cause generalized
aches and pains in the muscles for two to three days. This drug is
sometimes used routinely, though less so now than years ago, and also
has a special place in situations when the anesthesiologist needs to
place a breathing tube in the patient's throat (intubate) very quickly.
These pains, often referred to as scoline pains, are more prevalent in
very muscular and fit patients.
What Causes the Pain?
Although the problem of postoperative myalgia has been recognized for
many years, the exact way in which succinylcholine causes this muscle
pain is not fully understood. Most believe that it is due to
uncoordinated contraction of muscles that occurs a few seconds before
the muscle relaxation that is the desired effect of the drug.
Prevention of the Pain
It is also not clear how best to prevent scoline pain, short of
avoiding the use of this drug altogether. It is natural to ask then why
we continue to use this medication, and the reason is that
succinylcholine, despite a few significant side-effects, is a very
reliable and quick-acting muscle relaxant that helps the
anesthesiologist "secure" the airway (place a breathing tube).
Who is at Risk?
Muscle pain from succinylcholine is most common in young female
patients, especially those undergoing ambulatory surgery (going home the
same day as the surgery). The incidence of myalgia with succinylcholine
ranges widely - in some reports it's as low as 1.5% but can be as high
as 80 - 90%. To add to the mystery, some patients experience myalgia
even when they are not given succinylcholine at all, and other patients,
such as those given succinylcholine in the course of electroconvulsive
(shock) therapy do not seem to complain of myalgia at all!
How long to the effects last?
Postoperative myalgia does not normally go on for a long time and
usually it is symmetrical and affects muscles throughout the body
Typically the pain lasts 2 or 3 days and it can be quite severe.
Fortunately it does go away without specific treatment. Standard pain
medicines, such as acetaminophen can be prescribed.
What You Can Do
Talk to Your Anesthesiologist
If you've experienced muscle pain after previous anesthesia, you or
your anesthesiologist may be able to obtain the records of your previous
anesthetic and hospital stay. This will supply clues about what
happened to you during your last surgery. Be sure to discuss your
concerns with your anesthesiologist, whose job is to evaluate you
thoroughly and come up with a plan to provide you with a safe
anesthetic, with minimum side-effects.
Alternative Drugs
The good news is that there are other muscle relaxant drugs than can
almost always be used instead of succinylcholine. This will not
guarantee that you do not have the myalgia again but probably makes it
much less likely.
If the use of succinylcholine cannot be avoided, (this is rare),
there are methods for decreasing the incidence and severity of the
muscle pain, such as giving a very small dose of another muscle relaxant
before the succinylcholine, or by giving a local anesthetic medication
called lidocaine.
General Information on Succinylcholine or Scoline
SUCCINYLCHOLINE (Anectine®) is a muscle relaxant. It relaxes muscles
during surgery or before investigational procedures. Generic
succinylcholine injections are available. Succinylcholine is for
injection into a vein, or infusion into a vein. It is given by a
health-care professional in a hospital or clinic setting.
How much is given?
Your doctor or anesthesiologist will decide what dose of Scoline you
will receive. This depends on factors such as your weight, age, the type
of operation and the degree of muscle relaxation required.
How it is given?
Scoline is given as a slow injection or infusion into a vein
(intravenous). It is only used after the anaesthetic has made you fully
'asleep'.
Could I overdose?
As Scoline is given to you only by trained professional, it is very unlikely that you will receive too much.
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Last Reviewed: Oct 05, 2010
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Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University
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