Yazicioğlu Dilek, Caparlar Ceyda, Akkaya Taylan, Mercan Umit, Kulaçoğlu Hakan
From the Department of Anesthesiology (DY, CC, TA); and Department of General Surgery, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey (UM, HK).
Eur J Anaesthesiol. 2016 Mar;33(3):215-22. doi: 10.1097/EJA.0000000000000371.
α2-Agonists are used postoperatively as a component of multimodal analgesia. Tizanidine is a centrally acting α2-agonist with muscle relaxant properties.
The aim of this study was to compare the efficacy of tizanidine with placebo in terms of postoperative pain scores, analgesic consumption, return to daily activity and health-related quality of life.
A randomised double-blind study.
Diskapi Yildirim Beyazit Training and Research Hospital.
After obtaining ethical approval and informed patient consent, 60 patients undergoing inguinal hernia repair under general anaesthesia were randomly allocated into one of the two groups. The patients in Group T received tizanidine 4 mg orally 1 h before surgery and twice daily during the first postoperative week. The patients in Group P received the same treatment with a placebo pill. Both the groups received a standard analgesic treatment regimen comprising intravenous dexketoprofen 25 mg prior to induction of anaesthesia, dexketoprofen 25 mg orally three times daily for 1 week and intravenous paracetamol 1 g at the end of surgery. Supplemental analgesia was provided with paracetamol if the visual numerical rating scale (NRS) was at least 4 cm.
Postoperative pain was assessed using the NRS. Total analgesic consumption was determined. Return to normal daily activity was evaluated using a five-point daily activity score after the first postoperative week, and health-related quality of life was evaluated using the short form-36 one month after surgery.
The patients in Group T had significantly lower NRS pain scores than those in Group P 6, 12 and 24 h postoperatively both at rest and during movement (P < 0.001), and on postoperative days 1, 2, 3 and 4. The analgesic consumption was also lower in patients who received tizanidine. Ten patients (33%) in Group T and 23 patients (77%) in Group P consumed supplemental paracetamol (P < 0.001) after discharge. The daily activity score was lower in Group T than in Group P (P < 0.001), and the short form-36 scores were significantly different in the pain dimension [74 (74 to 100) in Group T and 74 (31 to 80) in Group P, (P < 0.001)] and in the physical component summary score.
The addition of tizanidine to the postoperative pain therapy after herniorrhaphy decreased postoperative pain and analgesic consumption and improved return to normal activity and quality of life.
ClinicalTrials.gov NCT02016443 (10 October 2013, Principal investigator D. Yazicioğlu).
α2 激动剂在术后被用作多模式镇痛的组成部分。替扎尼定是一种具有肌肉松弛特性的中枢性 α2 激动剂。
本研究旨在比较替扎尼定与安慰剂在术后疼痛评分、镇痛药物用量、恢复日常活动及健康相关生活质量方面的疗效。
一项随机双盲研究。
迪斯卡皮·耶尔德勒姆·贝亚齐特培训与研究医院。
在获得伦理批准并取得患者知情同意后，将 60 例行全身麻醉下腹股沟疝修补术的患者随机分为两组。T 组患者在手术前 1 小时口服 4 毫克替扎尼定，并在术后第一周每天服用两次。P 组患者接受相同治疗，但服用的是安慰剂药丸。两组均接受标准镇痛治疗方案，包括麻醉诱导前静脉注射右酮洛芬 25 毫克、术后 1 周每天口服右酮洛芬 25 毫克三次以及手术结束时静脉注射对乙酰氨基酚 1 克。如果视觉模拟评分法（NRS）至少为 4 厘米，则给予对乙酰氨基酚进行补充镇痛。
使用 NRS 评估术后疼痛。确定总镇痛药物用量。术后第一周后使用五点日常活动评分评估恢复正常日常活动情况，术后 1 个月使用简短健康调查问卷-36 评估健康相关生活质量。
T 组患者术后 6、12 和 24 小时在休息和活动时的 NRS 疼痛评分均显著低于 P 组（P < 0.001），术后第 1、2、3 和 4 天也是如此。接受替扎尼定治疗的患者镇痛药物用量也较低。T 组 10 名患者（33%）和 P 组 23 名患者（77%）出院后使用了补充对乙酰氨基酚（P < 0.001）。T 组的日常活动评分低于 P 组（P < 0.001），简短健康调查问卷-36 在疼痛维度[ T 组为 74（74 至 100），P 组为 74（31 至 80），（P < 0.001）]和身体成分汇总评分方面存在显著差异。
疝修补术后在疼痛治疗中添加替扎尼定可减轻术后疼痛和镇痛药物用量，并改善恢复正常活动及生活质量。
ClinicalTrials.gov NCT02016443（2013 年 10 月 10 日，主要研究者 D. Yazicioğlu）
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