Effect of oral tizanidine on local-anesthetic infiltration pain during epidural catheterization.

PURPOSE Tizanidine is a clonidine derivative and has the same effects, such as sedation, anxiolysis and analgesic response. We evaluated the effect of tizanidine on infiltration pain during epidural catheterization. METHODS Forty patients scheduled to undergo epidural anesthesia in elective surgery were randomly allocated into two groups. The control group received placebo 60 minutes before arrival in the operating room, and the tizanidine group received 3 mg of oral tizanidine as premedication 60 minutes before arrival in the operating room. Every patient was measured heart rate and blood pressure before receiving placebo or premedication and after arrival in the operating room. After an epidural catheter was indwelled, the patients were questioned about the infiltrating pain of local anesthetic, and the degree was assessed by means of visual analog scale score (VAS score, 0 to approximately 100 mm). RESULTS Blood pressure in the operating room was significantly attenuated in the tizanidine group compared to the control group (148 +/- 21 mmHg vs 130 +/- 15 mmHg). Heart rate was not significantly different between the two groups. Rate-pressure product was significantly lower in the tizanidine group (11282 +/- 2960 vs 9592 +/- 2632). VAS score in the tizanidine group was significantly lower than that in the control group (P <0.001). CONCLUSION It was possible to reduce the infiltration pain of local anesthetic during epidural catheterization by oral administration of 3 mg of tizanidine as premedication. Blood pressure and rate-pressure product in the operating room were also attenuated by receiving tizanidine. Therefore, we recommend premedication with tizanidine for patients undergoing epidural catheterization.

[1]  T. Kameyama,et al.  Antinociceptive action of tizanidine in mice and rats , 1985, Naunyn-Schmiedeberg's Archives of Pharmacology.

[2]  P. Maruff,et al.  Tizanidine — Initial pharmacokinetic studies in patients with spasticity , 2004, European Journal of Clinical Pharmacology.

[3]  T. Shiga,et al.  Oral tizanidine, an alpha2-adrenoceptor agonist, reduces the minimum alveolar concentration of sevoflurane in human adults. , 2002, Anesthesia and analgesia.

[4]  X. Hua,et al.  Inhibition of spinal protein kinase C blocks substance P-mediated hyperalgesia , 2000, Brain Research.

[5]  J. Eisenach,et al.  Intrathecal α2‐Adrenergic Agonists Stimulate Acetylcholine and Norepinephrine Release from the Spinal Cord Dorsal Horn in Sheep: An In Vivo Microdialysis Study , 1997 .

[6]  T. Vollmer,et al.  Relationship of the antispasticity effect of tizanidine to plasma concentration in patients with multiple sclerosis. , 1997, Archives of neurology.

[7]  M. Scheinin,et al.  The Sedative and Sympatholytic Effects of Oral Tizanidine in Healthy Volunteers , 1996, Anesthesia and analgesia.

[8]  N. Koyama,et al.  The Effects of Clonidine and Tizanidine on Responses of Nociceptive Neurons in Nucleus Ventralis Posterolateralis of the Cat Thalamus , 1995, Anesthesia and Analgesia.

[9]  K. Omote,et al.  [Effects of oral alpha 2 adrenergic agonists, clonidine and tizanidine, on tetracaine spinal anesthesia]. , 1995, Masui. The Japanese journal of anesthesiology.

[10]  M. Tryba,et al.  Dose-Response Effects of Intravenous Clonidine on Stress Response During Induction of Anesthesia in Coronary Artery Bypass Graft Patients , 1995, Anesthesia and analgesia.

[11]  Coward Dm.  Tizanidine: neuropharmacology and mechanism of action. , 1994 .

[12]  R. Roberts,et al.  Correlations between dose, plasma concentrations, and antispastic action of tizanidine (Sirdalud). , 1994, Journal of neurology, neurosurgery, and psychiatry.

[13]  J. Eisenach,et al.  Subarachnoid Neostigmine Potentiation of Alpha2-Adrenergic Agonist Analgesia: Dexmedetomidine versus Clonidine , 1994, Regional Anesthesia & Pain Medicine.

[14]  M. Scheinin,et al.  Alpha2‐adrenergic agents in anaesthesia , 1993, Acta anaesthesiologica Scandinavica.

[15]  M. Maze,et al.  Alpha 2 adrenoceptor agonists and anaesthesia. , 1993, British journal of anaesthesia.

[16]  J. Eisenach,et al.  Hemodynamic and Analgesic Actions of Epidurally Administered Clonidine , 1993, Anesthesiology.

[17]  Y. Dizdar,et al.  Effects of tizanidine on morphine physical dependence: Attenuation and intensification , 1992, Pharmacology Biochemistry and Behavior.

[18]  M. Maze,et al.  Synergistic Interaction Between α2-Adrenergic Agonists and Benzodiazepines in Rats , 1992 .

[19]  M. Maze,et al.  Clinical interactions with alpha-2-adrenergic agonists in anesthetic practice. , 1992, Journal of clinical anesthesia.

[20]  M. Maze,et al.  Synergistic interaction between alpha 2-adrenergic agonists and benzodiazepines in rats. , 1992, Anesthesiology.

[21]  J. Moore,et al.  Preanaesthetic medication with clonidine: a dose-response study. , 1991, British journal of anaesthesia.

[22]  M. Vasko,et al.  Inhibitory effects of clonidine and tizanidine on release of substance P from slices of rat spinal cord and antagonism by α-adrenergic receptor antagonists , 1991, Neuropharmacology.

[23]  M. Maze,et al.  Alpha‐2 Adrenoceptor Agonists: Defining the Role in Clinical Anesthesia , 1991, Anesthesiology.

[24]  R. Penn,et al.  Effect of intrathecal tizanidine on antinociception and blood pressure in the rat , 1990, Pain.

[25]  J. Becquemin,et al.  Aortic surgery: effect of clonidine on intraoperative catecholaminergic and circulatory stability , 1990, Acta anaesthesiologica Scandinavica.

[26]  J. Davies.  Effects of tizanidine, eperisone and afloqualone on feline dorsal horn neuronal responses to peripheral cutaneous noxious and innocuous stimuli , 1989, Neuropharmacology.

[27]  P Koch,et al.  Biological fate of sirdalud in animals and man. , 1989, Xenobiotica; the fate of foreign compounds in biological systems.

[28]  C J Mathias,et al.  Pharmacodynamics and pharmacokinetics of the oral antispastic agent tizanidine in patients with spinal cord injury. , 1989, Journal of rehabilitation research and development.

[29]  R. Millard,et al.  Clonidine premedication for isoflurane-induced hypotension. Sympathoadrenal responses and a computer-controlled assessment of the vapour requirement. , 1988, British journal of anaesthesia.

[30]  M. Maze,et al.  Clonidine and other alpha2 adrenergic agonists: strategies for the rational use of these novel anesthetic agents. , 1988, Journal of clinical anesthesia.

[31]  F. Tse,et al.  PHARMACOKINETICS OF ORALLY ADMINISTERED TIZANIDINE IN HEALTHY VOLUNTEERS , 1987, Fundamental & clinical pharmacology.

[32]  R. Thisted,et al.  IS INCREASED OPERATIVE STRESS ASSOCIATED WITH WORSE OUTCOME , 1987 .

[33]  D. Longnecker.  Alpine anesthesia: can pretreatment with clonidine decrease the peaks and valleys? , 1987, Anesthesiology.

[34]  B. C. Bloor,et al.  Reduced Narcotic Requirement by Clonidine with Improved Hemodynamic and Adrenergic Stability in Patients Undergoing Coronary Bypass Surgery , 1987, Anesthesiology.

[35]  T. Kameyama,et al.  Antinociceptive activity induced by tizanidine and alpha 2-adrenoreceptors. , 1987, Neuropharmacology.

[36]  T. Kameyama,et al.  Comparison of alpha-adrenoceptor involvement in the antinociceptive action of tizanidine and clonidine in the mouse. , 1986, European journal of pharmacology.

[37]  J. E. Quinlan,et al.  Selective inhibition of responses of feline dorsal horn neurones to noxious cutaneous stimuli by tizanidine (DS103-282) and noradrenaline: Involvement ofα2-adrenoceptors , 1985, Neuroscience.

[38]  J. Sagen,et al.  Effect of intrathecally administered noradrenergic antagonists on nociception in the rat , 1984, Brain Research.

[39]  J. Cruz,et al.  The Rate Pressure Product: Fact or Fallacy? , 1982, Angiology.

[40]  H. Müller-Fassbender,et al.  Tizanidine (DS 103-282) in the Treatment of Acute Paravertebral Muscle Spasm: A Controlled Trial Comparing Tizanidine and Diazepam , 1981, The Journal of international medical research.

[41]  C. Dollery,et al.  Absence of opiate and histamine H2 receptor–mediated effects of Clonidine , 1980, Clinical pharmacology and therapeutics.

[42]  H. Bürki,et al.  The pharmacology of 5-chloro-4-(2-imidazolin-2-yl-amino)-2,1,3-benzothiadiazole (DS 103-282), a novel myotonolytic agent. , 1980, Arzneimittel-Forschung.

[43]  YANG WANG,et al.  The Rate-Pressure Product as an Index of Myocardial Oxygen Consumption during Exercise in Patients with Angina Pectoris , 1978, Circulation.