Dexmedetomidine Reduces Myalgia in ECT: Study From India

 Out on PubMed, from authors in India, is this study:

Dexmedetomidine for reducing succinylcholine-induced myalgia in patients undergoing electroconvulsive therapy: A randomised controlled trial.

Sriramka B, Panigrahy S, Ramasubbu MK, Mishra SN.Indian J Anaesth. 2024 Jun;68(6):560-565. doi: 10.4103/ija.ija_1159_23. Epub 2024 May 8.PMID: 38903251

The abstract is copied below:

Background and aim: Electroconvulsive therapy (ECT) is an effective intervention for psychiatric patients. Succinylcholine is considered the drug of choice for muscle relaxation for ECT. Significant adverse effects of succinylcholine include fasciculation and myalgia. Dexmedetomidine is a highly selective α-2 adrenergic agonist. This study aims to determine the efficacy of a low dose of dexmedetomidine in reducing succinylcholine-induced myalgia in patients receiving ECT.

Methods: This randomised controlled trial was conducted on 100 patients, aged 18-65 years, undergoing ECT, who were randomly allocated into two groups with an allocation ratio of 1:1. Group D received intravenous (IV) dexmedetomidine 0.25 µg/kg, and Group C received IV normal saline (0.9%). Patients' self-reported myalgia scores were measured after 60 min of the procedure. Fasciculations were noted after IV succinylcholine administration. Heart rate (HR) and mean blood pressure (MBP) were measured at baseline, after infusion (5 min) and after ECT (0, 2.5, 5, 10, 15, 30 min). Continuous data were analysed using a Student's t-test for two-group comparisons, a mixed model analysis of variance for group comparisons and various time point analyses. Categorical data were analysed using the Chi-square/Fisher's exact test.

Results: There were no differences between the groups regarding demographics. Myalgia and fasciculations were less in Group D than in Group C (P < 0.001). MBP and HR changes were comparable (P > 0.05).

Conclusion: A low dose of dexmedetomidine (0.25 µg/kg) effectively reduces myalgia and fasciculations due to succinylcholine in patients undergoing electroconvulsive therapy.

Keywords: Dexmedetomidine; electroconvulsive therapy; fasciculation; myalgia; succinylcholine.

The article is here.

And from the text:

This is a well-conducted, and well-presented study with an interesting positive finding. But did it really need to be done? Of course, patient comfort is a laudable goal in ECT, and this is a step in that direction. But treating myalgias with an NSAID is easy enough, and ECT should be as uncomplicated as possible. And I always felt that fasciculations were our friends, enabling the practitioner to see exactly when the sux had worked maximally (after they subside in the toes). 

On the other hand, this study supports my contention that, for its multiple benefits, a touch of dexmedetomidine will be a part of the optimized ECT anesthesia cocktail in the future...