Document Type : Original Article
- Arman Taheri 1
- Morteza Hashemian 2
- Mehrdad Noroozi 2
- Mohammad Bakhtiari 3
- Mohammad Reza Doroodian 2
- Shirin Salajegheh 2
1 Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Anesthesiology, Kerman University of Medical Sciences, Kerman, Iran
3 Department of Anesthesiology, Sirjan School of Medicine, Sirjan, Iran
Objective: In order to prolong the duration of intrathecal lidocaine, various drugs are used along with it. Due to the promising effects of tizanidine on central nervous system, it can be assumed that tizanidine can have a positive effect on increasing the anesthesia duration too. Thus, we aimed to investigate the effect of oral tizanidine on the duration of lidocaine spinal anesthesia.
Methods: This double blind clinical trial was conducted on 40 male patients waiting for elective leg surgery with the age range of 20-60 years in one of the educational hospitals of Kerman University of Medical Sciences, Iran. We used simple random sampling and our participants were assigned into 2 groups (placebo and oral tizanidine receivers). Spinal anesthesia with 1 mg/kg of hyperbaric lidocaine 5% was performed in both groups. In tizanidine group, patients received 4 mg of oral tizanidine one hour before spinal anesthesia. Sensory block was examined by pin prick test and all anesthetic duration including start block until reduction of sensory level was calculated at 2 lower dermatomes.
Results: Findings showed that oral tizanidine compared to placebo can cause a 10-15 minute increase in patients’ lidocaine spinal anesthesia. Therefore, the average anesthesia time for tizanidine group increased meaningfully (P = 0.03). In addition, tizanidine can sedate patients during surgery (P = 0.00) or in recovery (P = 0.003).
Conclusion: Based on the results, tizanidine increased the duration of lidocaine so oral tizanidine can be used to prolong the duration of lidocaine spinal anesthesia.
2. Montazeri K, Ghobadin AH. Effect of oral clonidine as premedication on duration OF block hemodynamic changes and need of ephedrine on spinal anesthesia. Journal of Iranian Society of Anesthesiology & Intensive Care 2004; 25: 75-6.
3. Drasner K, Larson M. Spinal and epidural anesthesia. In: Stoelting RK, Miller RD, eds. Basics of Anesthesia. 5th ed.
Philadelphia: Churchill Livingstone; 2007. p. 241-71.
4. Elia N, Culebras X, Mazza C, Schiffer E, Tramer MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med 2008; 33(2): 159-67. doi: 10.1016/j. rapm.2007.10.008.
5. Gabriel JS, Gordin V. Alpha 2 agonists in regional anesthesia and analgesia. Curr Opin Anaesthesiol 2001; 14(6): 751-3.
6. Imanaga K, Wajima Z, Inoue T, Ogawa R. Effect of oral tizanidine on local-anesthetic infiltration pain during epidural catheterization. J Nippon Med Sch 2004; 71(2):105-10. doi: 10.1272/jnms.71.105.
7. Miettinen TJ, Kanto JH, Salonen MA, Scheinin M. The sedative and sympatholytic effects of oral tizanidine in healthy volunteers. Anesth Analg 1996; 82(4): 817-20. doi:10.1213/00000539-199604000-00024.
and tizanidine, on tetracaine spinal anesthesia]. Masui 1995; 44(6): 816-23. [In Japanese].
9. Asgari Z, Rezaeinejad M, Hosseini R, Nataj M, Razavi M, Sepidarkish M. Spinal Anesthesia and Spinal Anesthesia with Subdiaphragmatic Lidocaine in Shoulder Pain Reduction for Gynecological Laparoscopic Surgery: A Randomized Clinical Trial. Pain Res Manag 2017; 2017:1721460. doi: 10.1155/2017/1721460.
10. Rupani M, Alijanpour E, Banihashem N, Alipour A, Shirkhani Z, Solimanian S. Effect of Oral Tizanidine on Postoperative Pain after Perianal Surgery. J Babol Univ Med Sci 2013; 15(4): 7-11. doi: 10.18869/acadpub.jbums.15.4.7.
11. Shoeibi G, Soltani Mohammadi S, Ahangari A, Marashi S, Borji A, Yaghooti AA. Effects of Oral Tizanidine Premedication on Pain and Hemodynamic Responses after Spinal Needle Skin Puncture. Archives of Anesthesiology and Critical Care 2015; 1(1): 18-20.
12. Talakoub R, Abbasi S, Maghami E, Zavareh SM. The effect of oral tizanidine on postoperative pain relief after elective
laparoscopic cholecystectomy. Adv Biomed Res 2016; 5: 19. doi: 10.4103/2277-9175.175905.
13. Henney HR 3rd, Chez M. Pediatric safety of tizanidine: clinical adverse event database and retrospective chart assessment. Paediatr Drugs 2009; 11(6): 397-406. doi:10.2165/11316090-000000000-00000.