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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

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University