Conference Coverage

Can Nondepolarizing Neuromuscular Blocking Agents Improve Postoperative Recovery by Reducing Myalgias?

Anthony Calabro, MA

Key Highlights

  • Nondepolarizing neuromuscular blocking agents (nNMBA) were associated with significantly lower rates of postoperative myalgias than succinylcholine, a short-acting muscle relaxant.
  • Myalgias were linked to poorer quality of recovery (QoR) scores across all patient-reported domains.
  • Use of succinylcholine, younger age, and gynecologic surgery were associated with increased risk of myalgias.
  • The odds of experiencing myalgias were 78% lower with nNMBA use compared with succinylcholine.

Patients who received nondepolarizing neuromuscular blocking agents (nNMBAs) during outpatient procedures had significantly lower rates of postoperative myalgias and better quality of recovery (QoR) scores compared with those who received the short-acting muscle relaxant succinylcholine, according to results of a study presented at the American Association of Nurse Anesthesiology (AANA) 2025 Annual Congress.

Postoperative myalgias are reported in 35% to 40% of patients administered succinylcholine and can negatively impact patient satisfaction and early recovery in the first 24-72 hours post-surgery. Prior quality improvement work explored the relationship between succinylcholine and postoperative discomfort, but the incidence and recovery impact in patients receiving nNMBAs remained unclear.

To fill this gap, Malia Rosenlund, BSN, RN, SRNA, and her colleagues at the Mayo Clinic School of Health Science developed a prospective cohort study that enrolled 200 adult patients undergoing ambulatory surgery with nNMBA use, excluding those under 18 years of age, those who received succinylcholine (for primary analysis), and non-English speakers. Myalgias were assessed using patient surveys conducted via phone or email within 1 week of surgery. Patients rated muscle pain/stiffness outside the surgical site on a 0–10 scale. Recovery was evaluated using the validated QoR-15 questionnaire. These outcomes were compared with previously collected data from a 373-patient succinylcholine cohort. Statistical analyses included Kruskal-Wallis tests, Fisher’s Exact tests, and multivariable logistic regression.

The incidence of postoperative myalgias was 20.5% in the nNMBA cohort. Factors associated with higher myalgia risk included younger age, female sex, gynecologic surgery, longer surgery duration, and higher total doses of rocuronium.

When data were combined with the succinylcholine group, the adjusted odds ratio (OR) for developing myalgias was significantly lower for nNMBAs (OR, 0.22; 95% CI, 0.12–0.39; P <.001). Conversely, gynecologic procedures were associated with increased odds (OR, 3.67; 95% CI, 1.46–9.44). Myalgias were strongly correlated with poorer QoR scores, with affected patients averaging a total score of 114.6 compared with 127.5 in those without myalgias.

This study was limited by the lack of a validated tool for diagnosing postoperative myalgias, the potential for recall bias due to survey timing, and demographic variations between cohorts. Additional variables such as surgical positioning were not assessed.

“Reports of postoperative myalgias are associated with overall poorer quality of recovery,” Rosenlund and colleagues concluded. “Using a nondepolarizing NMBA instead of succinylcholine may decrease the incidence of postoperative myalgias. Anesthesia providers must be mindful of drug side effects and impact on patient recovery when selecting the type of NMBA.”

Reference:
Rosenlund M, Kangas J, Hidalgo V, et al. Quality of recovery and incidence of myalgias following anesthesia with nondepolarizing vs. depolarizing neuromuscular blockade in ambulatory surgical patients. Poster presented at: AANA Annual Congress; August 9-13, 2025; Nashville, TN. https://www.aana.com/premier-event/annual-congress/