A Randomized Controlled Trial to Compare Preemptive Analgesic Efficacy and Safety of Pregabalin and Gabapentin for Succinylcholine-Induced Myalgia

Background: Succinylcholine is a drug of choice for rapid induction of anesthesia but produces postoperative myalgia. Preemptive analgesia is intended to decrease perception of pain before exposure to painful stimuli. Pregabalin and gabapentin, analogs of the inhibitory neurotransmitter gamma aminobutyric acid, are effective in several models of neuropathic pain, incisional, inflammatory, and formalin-induced injury. However, the data available on their preemptive analgesic efficacy in succinylcholine myalgia are sparse. This study was designed to compare the preemptive analgesic efficacy and safety of pregabalin and gabapentin. Materials and Methods: This randomized clinical trial included 120 surgical patients of either sex, between 18 and 70 years, and of American Society of Anesthesiologists-I/II grade. Patients were randomly allocated to control and test groups; received respective treatments 30 min before induction of anesthesia. Myalgia and pain scores were recorded using the myalgia scale and visual analog/facial rating scale at awakening at 6, 12, 18, and 24 h, respectively. Postoperative analgesic requirement over 24 h was recorded. Data were analyzed using OpenEpi (Andrew G. Dean and Kevin M. Sullivan, Atlanta, GA, USA) statistical softwares. Results: Significantly lower pain scores were observed in the pregabalin group at 6, 12, and 24 h, and in gabapentin group at 24 h as compared to control and placebo (P < 0.05). They were however found to be equianalgesic when compared to each other (P > 0.05). Pregabalin-treated patients were more comfortable throughout with significantly less postoperative myalgia and analgesic requirement (P < 0.05). Conclusions: Results strongly suggest the preemptive analgesic efficacy of a single oral dose of pregabalin and gabapentin over diclofenac in postoperative myalgia and pain management. However, on the basis of safety profile, pregabalin may be preferred over gabapentin in succinylcholine-induced myalgia.