Nair Abhijit, Rangaiah Manamohan, Borkar Nitin
Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, P.O. Box 275, Ibra-414, Sultanate of Oman.
Department of Anaesthetics and Pain Management, Walsall Manor Hospital Moat Rd., Walsall WS2 9PS, United Kingdom.
Saudi J Anaesth. 2023 Apr-Jun;17(2):214-222. doi: 10.4103/sja.sja_780_22. Epub 2023 Mar 10.
Tizanidine is a centrally acting α2 agonist which has been used as a premedication due to its opioid-sparing and sympatholytic properties. This systematic review assessed the safety and feasibility of oral tizanidine. After registering the protocol with PROSPERO (CRD42022368546), randomized controlled trials and non-randomized observational studies were searched in various databases. The primary outcome was intraoperative opioid use; the secondary outcomes were 24-hr opioid consumption, pain scores, time to rescue analgesia, and adverse events. The risk of bias scale was used to assess the quality of evidence. Out of 202 studies identified, five studies fulfilled the inclusion criteria. Intraoperative opioid consumption was significantly less in the tizanidine group (MD: -2.40; 95% CI: -4.22, -0.59; = 0.010; I = 0 %). The 24-hr opioid consumption was comparable between both groups (MD: -42.53, 95% CI: -91.45, 6.39; = 0.09; I = 99%). Time to rescue analgesia was comparable between both groups (MD: 308.22; 95% CI: -263.67, 880.11, = 0.29, I = 100%). Pain scores at 6 and 12 hours were comparable (MD: -1.37; 95% CI: -3.68, 0.94; = 0.24; I = 97%) and (MD: -1.76; 95% CI: -4.06, 0.53; = 0.13; I = 95%); however, at 24 hours the scores were better in the tizanidine group (MD: -1.10; 95% CI: -1.50, -0.69; < 0.0001 I = 0%). Although dry mouth was significantly more in the tizanidine group (MD: 5.35; 95% CI: 1.72, 16.62; = 0.004; I = 0%), postoperative nausea/vomiting and dizziness were comparable. Tizanidine reduces intraoperative opioid consumption without significant adverse events. However, it does not provide effective opioid-sparing analgesia or reduced opioid requirement in the first 24 hours after surgery.
替扎尼定是一种中枢性作用的α2激动剂，因其具有节省阿片类药物和抗交感神经的特性，已被用作术前用药。本系统评价评估了口服替扎尼定的安全性和可行性。在向国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42022368546）注册方案后，在多个数据库中检索了随机对照试验和非随机观察性研究。主要结局是术中阿片类药物的使用；次要结局包括24小时阿片类药物消耗量、疼痛评分、补救镇痛时间和不良事件。采用偏倚风险量表评估证据质量。在检索到的202项研究中，有5项研究符合纳入标准。替扎尼定组术中阿片类药物消耗量显著较少（MD：-2.40；95%CI：-4.22，-0.59；P = 0.010；I² = 0%）。两组间24小时阿片类药物消耗量相当（MD：-42.53，95%CI：-91.45，6.39；P = 0.09；I² = 99%）。两组间补救镇痛时间相当（MD：308.22；95%CI：-263.67，880.11；P = 0.29；I² = 100%）。6小时和12小时时的疼痛评分相当（MD：-1.37；95%CI：-3.68，0.94；P = 0.24；I² = 97%）以及（MD：-1.76；95%CI：-4.06，0.53；P = 0.13；I² = 95%）；然而，在24小时时，替扎尼定组的评分更好（MD：-1.10；95%CI：-1.50，-0.69；P < 0.0001；I² = 0%）。虽然替扎尼定组口干明显更多（MD：5.35；95%CI：1.72，16.62；P = 0.004；I² = 0%），但术后恶心/呕吐和头晕相当。替扎尼定可减少术中阿片类药物的消耗，且无明显不良事件。然而，它并不能在术后最初24小时提供有效的节省阿片类药物的镇痛效果或减少阿片类药物的需求量。
