AANA Journal /October 2002/Vol. 70, No. 5 367 Succinylcholine is a depolarizing muscle relaxant first introduced into clinical practice in 1951; it remains the drug of choice in clinical situations in which rapid paralysis and airway control are priorities. The admin- istration of succinylcholine may produce postopera- tive myalgia (POM) that has an overall incidence ranging from 5% to 83%. 1-5 Postoperative myalgia is thought to be caused by motor units firing at physio- logically high rates following succinylcholine admin- istration, leading to unsynchronized muscle contrac- tions causing shearing forces of skeletal muscle fibers. 3 However, several studies have reported that the severity of fasciculations does not correlate directly with an increase in the incidence and severity of POM. 6-8 It has been shown that the administration of a sub- clinical dose of a nondepolarizing muscle relaxant such as rocuronium before the administration of suc- The incidence of postoperative myalgia (POM) after suc- cinylcholine administration has been reported to range from 5% to 83%. The administration of small doses of nondepolarizing muscle relaxants or lidocaine before the administration of succinylcholine has been shown to decrease the incidence and severity of POM experienced by patients. The purpose of this investigation was to com- pare the severity of POM in subjects receiving pretreat- ment with rocuronium or lidocaine. Seventy-four subjects were enrolled in this random- ized, double-blind investigation to measure the effect of pretreatment modalities on the incidence and severity of myalgia following succinylcholine administration. Pre- treatment consisted of either lidocaine, 1.5 mg/kg, or rocuronium, 0.03 mg/kg. Myalgia was measured using a 4-point ordinal scale. Ordinal and nominal data were ana- lyzed using a χ 2 test and the Fisher exact test. A P value of less than .05 was considered significant. Data for 53 subjects were included in the analysis. Of the lidocaine group, 21 (72%) of 29 reported no myalgia at 48 hours compared with only 9 (38%) of 24 in the rocuronium group ( P = 0.023). Satisfaction was similar between the groups. Based on the results of this study, pretreatment with lidocaine may provide better relief from myalgia than rocuronium at 48 hours after surgery. Key words: Fasciculations, lidocaine, postoperative myal- gia, rocuronium, succinylcholine. A comparison of rocuronium and lidocaine for the prevention of postoperative myalgia after succinylcholine administration LT Dennis Spence, CRNA, MS, NC, USN Camp Pendleton, California LCDR Ramona Domen-Herbert, CRNA, MS, NC, USN Naval Hospital Guam, Guam LCDR Elizabeth Boulette, CRNA, MS, NC, USN CDR R. Lee Olson, CRNA, MS, NC, USN San Diego, California CDR Charles Vacchiano, CRNA, PhD, NC, USN Pensacola, Florida LCDR John Maye, CRNA, PhD, NC, USN San Diego, California cinylcholine results in a decrease in the incidence and severity of postoperative myalgia in patients given succinylcholine. 5-14 Several research investigations have compared pretreatment with rocuronium with various other nondepolarizing neuromuscular block- ing agents such as atracurium, d-tubocurarine, cis- atracurium, and vecuronium and found rocuronium to be as effective or significantly better in decreasing the incidence and severity of POM. 10,12-15 However, a 1990 meta-analysis that analyzed the studies investigating treatment modalities for the pre- vention of POM found inconsistent research methods in most of the investigations. 2 These inconsistencies included lack of randomization of subjects, no control for type of surgical procedure, degree of underlying disease, differences in physical condition or level of activity, or rapidity of postoperative ambulation. 2,8 In addition, several lacked pretreatment with equipotent