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Anesth Pain Med > Volume 18(4); 2023 > Article |
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DATA AVAILABILITY STATEMENT
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
AUTHOR CONTRIBUTIONS
Conceptualization: Ricardo Verdiner, Narjeet Khurmi, Christopher Choukalas, Colby Erickson, Karl Poterack.
Data curation: Narjeet Khurmi, Colby Erickson.
Formal analysis: Ricardo Verdiner, Christopher Choukalas.
Methodology: Ricardo Verdiner, Narjeet Khurmi, Christopher Choukalas, Colby Erickson, Karl Poterack.
Project administration: Ricardo Verdiner.
Visualization: Ricardo Verdiner, Narjeet Khurmi. Writing - original draft: Ricardo Verdiner, Christopher Choukalas, Colby Erickson.
Writing - review & editing: Ricardo Verdiner, Narjeet Khurmi, Christopher Choukalas, Colby Erickson, Karl Poterack.
Investigation: Ricardo Verdiner, Narjeet Khurmi, Christopher Choukalas, Colby Erickson, Karl Poterack.
Resources: Colby Erickson.
Supervision: Ricardo Verdiner. Validation: Ricardo Verdiner, Narjeet Khurmi, Colby Erickson, Karl Poterack.
Drug [5] | Site of action |
---|---|
Baclofen | Binds to the GABA-B receptor and reduces release of excitatory neurotransmitters and substance P. |
Cyclobenzaprine | Exact mechanism is unknown. Postulated to inhibit serotonergic descending systems in the spinal cord. |
Metaxalone | Exact mechanism unknown. Speculated to be a general CNS depressant. |
Methocarbamol | Exact mechanism unknown. Possibly inhibition of acetylcholinesterase at the synapse at autonomic nervous system, neuromuscular junction and CNS. |
Orphenadrine | Exact mechanism unknown. Appears to block muscarinic acetylcholine receptors and NMDA receptors in the CNS |
Tizanidine | Presynaptic alpha-2 agonist which directly impairs excitatory amino acid release from spinal interneurons. |
GABA-B: G-protein coupled receptor for gamma-aminobutyric acid, NMDA: N-methyl-D-aspartic acid, CNS: central nervous system. All pharmacologic information can be found on Drugbank.com [5].
Drug [5] | Onset | Duration | Half-life |
---|---|---|---|
Baclofen | 1-2 h | Not reported | 5.5 h |
Cyclobenzaprine | 1 h | 4-6 h | 2-3 h |
Metaxalone | 30 min | Not reported | 1-2 h |
Methocarbamol | 1 h | 4-5 h | 14 h |
Orphenadrine | 1 h | 12-24 h | 1-3 days |
Tizanidine | 0.75-2 h | 6-8 h | 2.1-4.2 h |
All pharmacologic information can be found on Drugbank.com [5].
Region of the body | Surgery | Study type | CASMR studied | Conclusions | Author/year |
---|---|---|---|---|---|
Head | Craniotomy | Literature Review | Methocarbamol [29] | Multimodal analgesia with non-opioid Rx, regional anesthesia (scalp block) and CASMR advocated to reduce perioperative opioid use | Ban et al. 2019 [29] |
Removal affected 3rd molar | RCT* | Cyclobenzaprine [45] | No statistical difference in CASMR vs. non-CASMR groups for pain scores, trismus or need for supplemental analgesia | De Santana Santos et al. 2011 [45] | |
Removal affected 3rd molar | RCT* | Orphenadrine Cyanocobalamin [57] | Statistically significant decrease VAS pain scores in CASMR group; no statistical decrease in acetaminophen consumption in CASMR group | Barroso et al. 2006 [57] | |
Removal affected 3rd molar | RCT | Baclofen [58] | No statistical difference in CASMR vs. non-CASMR groups in time interval to initial opioid consumption | Gordon et al. 1995 [58] | |
Removal affected 3rd molar | RCT | Tizanidine [44] | No statistical difference in CASMR vs. non-CASMR group for VAS pain scores | Kirmeier et al. 2007 [44] | |
Thyroidectomy | RCT* | Tizanidine [42] | Statistically significant less postoperative cervical pain, headache opioid consumption in CASMR group vs. non-CASMR groups | Ahiskalioglu et al. 2018 [42] | |
Thorax | Breast Reconstruction | RCT | Cyclobenzaprine [20] | No statistical difference between CASMR vs. non-CASMR group | Al Yafi et al. 2021 [20] |
Breast augmentation | RCT | Methocarbamol [22] | No statistical difference in CASMR vs. non-CASMR group after 3 h opostoperative | Hidalgo and Pusic, 2005 [22] | |
Breast augmentation | Observational | Methocarbamol [21] | Subjectively CASMR effective | Schneider, 1997 [21] | |
Pectus | Retrospective review | Methocarbamol [46] | Patients in the multimodal analgesia protocol with CASMR had decreased hospital length of stay | Inge et al. 2003 [46] | |
Spine | Posterior spinal arthrodesis (pediatrics) | Retrospecive review | Cyclobenzaprine Methocarbamol [59] | Increase in CASMR prescriptions tied to decrease in opioid prescriptions | Harris et al. 2020 [59] |
Posterior spinal fusion | Case report | Baclofen [25] | Possible to deliver opioid-free anesthetic with erector spinae plane blocks, ketamine, dexmedetomidine, acetaminophen and baclofen | Chin and Lewis, 2019 [25] | |
Cervical and lumbar discectomy/decompression/fusion | RCT | Chlorzoxazone [24] | No statistical difference in CASMR vs. non-CASMR group in reducing pain at rest or with mobilization, or total opioid consumption | Nielsen et al. 2016 [24] | |
Spine surgery | RCT | Baclofen [26] | No statistical difference in CASMR vs. non-CASMR groups in opioid consumption POD 1-3 ; statistically significant reduction in muscle spasms in CASMR group POD 2-3 | Blumenkopf, 1987 [26] | |
Spine fusion | RCT | Myanesin [23] | No statistical difference in CASMR vs. non-CASMR group in postoperative opioid use | Selvin, 1954 [23] | |
Abdomen | Hemorrhoidectomy | RCT* | Baclofen [41] | Statistically significant lower VAS pain scores and analgesic consumption only at 1 and 2 weeks postop in CASMR group vs. non-CASMR group | Ala et al. 2020 [41] |
Inguinal hernia repair | RCT* | Tizanidine [37] | Statistically significant decrease in NRS pain scores from POD 0-4 at rest and with movement in CASMR group; CASMR group with longer interval to request supplemental analgesia; CASMR group with less overall use of supplemental oral analgesia | Yazicioğlu et al. 2016 [37] | |
Major abdominal surgery | RCT | Orphenadrine [30] | Statistically significant longer interval to request supplemental analgesia in CASMR group | Fry, 1979 [30] | |
Limb | Total knee arthroplasty | RCT* | Epirisone [28] | Statistically significant decrease in VAS at rest and ambulation from POD 3 onwards in CASMR group better active ROM in CASMR group POD 3-14; less total morphine use in CASMR group | Gong et al. 2013 [28] |
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