Is succinylcholine after pretreatment with d-tubocurarine and lidocaine contraindicated for outpatient anesthesia?

Because succinylcholine has obvious advantages for facilitating endotrachea l intubation in the ambulatory setting (e.g., low cost, fast onset, and no need for reversal of neuromuscular block), it is important to determine whe ther this muscle relaxant is indeed associated with an increased incidence of postoperative myalgias, compared with alternative but more expensive non depolarizing muscle relaxants. We studied 119 outpatients undergoing endosc opic nasal sinus surgery or septoplasty. The anesthetic technique consisted of propofol/lidocaine for induction, followed by isoflurane/nitrous oxide/ oxygen for maintenance. Ord tracheal intubation was performed by using a fi berscope. Patients were randomly assigned to one of two muscle relaxant gro ups. Group 1 patients received n-tubocurarine 3 mg followed by succinylchol ine 1.5 mg/kg. Group 2 patients received mivacurium 0.2 mg/kg. After recove ry from anesthesia, patients were asked whether they had any muscle pain an d/or stiffness. Pain was categorized by location and quantified by using a verbal scale (from 0 to 10). Analgesic usage and myalgias limiting ambulati on were recorded. After discharge from the ambulatory surgery unit, patient s were contacted by telephone on Postoperative Day 1. If patients complaine d of myalgias, they were contacted by telephone on Days 2 and 3. Only one p atient (in the mivacurium-treated group) reported myalgia as a limiting fac tor in ambulation or resumption of normal activity. There were no differenc es between groups with respect to the incidence (21% in the succinylcholine -treated group and 18% in the mivacurium-treated group), location, or sever ity of myalgia. In conclusion succinylcholine (preceded by pretreatment wit h d-tubocurarine and lidocaine) is not associated with an increased inciden ce of myalgias, compared with mivacurium, when used to facilitate tracheal intubation in patients undergoing ambulatory nasal surgery.