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L M Bouter - One of the best experts on this subject based on the ideXlab platform.
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Muscle Relaxants for non specific low back pain
Cochrane Database of Systematic Reviews, 2003Co-Authors: Maurits W Van Tulder, Andrea D Furlan, Tony Touray, Sherra Solway, L M BouterAbstract:Background The use of Muscle Relaxants in the management of non-specific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. Objectives The aim of this review was to determine if Muscle Relaxants are effective in the treatment of non-specific low back pain. Search methods A computer-assisted search of the Cochrane Library (Issue 3, 2002), MEDLINE (1966 up to October 2002) and EMBASE (1988 up to October 2002) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Selection criteria Randomised and/or double-blinded controlled trials, involving patients diagnosed with non-specific low back pain, treated with Muscle Relaxants as monotherapy or in combination with other therapeutic modalities, were included for review. Data collection and analysis Two authors independently carried out the methodological quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong", "moderate", "limited", "conflicting" or "no" evidence. Main results Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality, 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 non-benzodiazepines and two antispasticity Muscle Relaxants in comparison with placebo. Results showed that there is strong evidence that any of these Muscle Relaxants are more effective than placebo for patients with acute LBP on short-term pain relief. The pooled RR for non-benzodiazepines versus placebo after two to four days was 0.80 [95% CI; 0.71 to 0.89] for pain relief and 0.49 [95% CI; 0.25 to 0.95] for global efficacy. Adverse events, however, with a relative risk of 1.50 [95% CI; 1.14 to 1.98] were significantly more prevalent in patients receiving Muscle Relaxants and especially the central nervous system adverse effects (RR 2.04; 95% CI; 1.23 to 3.37). The various Muscle Relaxants were found to be similar in performance. Authors' conclusions Muscle Relaxants are effective in the management of non-specific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if Muscle Relaxants are more effective than analgesics or non-steroidal anti-inflammatory drugs.
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Muscle Relaxants for nonspecific low back pain a systematic review within the framework of the cochrane collaboration
Spine, 2003Co-Authors: Maurits W Van Tulder, Andrea D Furlan, Tony Touray, Sherra Solway, L M BouterAbstract:STUDY DESIGN: A systematic review of randomized and/or double-blinded controlled trials. SUMMARY OF BACKGROUND DATA: The use of Muscle Relaxants in the management of nonspecific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. OBJECTIVES: The aim of this review was to determine if Muscle Relaxants are effective in the treatment of nonspecific low back pain. METHODS: A computer-assisted search of the Cochrane Library (Issue 2, 2002), MEDLINE (1966 up to October 2001), and EMBASE (1988 up to October 2001) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Randomized and/or double-blinded controlled trials, involving patients diagnosed with nonspecific low back pain, treated with Muscle Relaxants as monotherapy or in combination with other therapeutic methods, were included for review. Two reviewers independently carried out the methodologic quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong," "moderate," "limited," "conflicting," or "no" evidence. RESULTS: Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality; 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 nonbenzodiazepines, and 2 antispasticity Muscle Relaxants in comparison with placebo. Results showed that there is strong evidence that any of these Muscle Relaxants are more effective than placebo for patients with acute low back pain on short-term pain relief. The pooled relative risk for nonbenzodiazepines versus placebo after 2 to 4 days was 0.80 (95% confidence interval: 0.71 to 0.89) for pain relief and 0.49 (95% confidence interval: 0.25 to 0.95) for global efficacy. Adverse events, however, with a relative risk of 1.50 (95% confidence interval: 1.14 to 1.98) were significantly more prevalent in patients receiving Muscle Relaxants and especially the central nervous system adverse effects (relative risk 2.04; 95% confidence interval: 1.23 to 3.37). The various Muscle Relaxants were found to be similar in performance. CONCLUSIONS: Muscle Relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if Muscle Relaxants are more effective than analgesics or nonsteroidal anti-inflammatory drugs
Andrew J Mclachlan - One of the best experts on this subject based on the ideXlab platform.
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efficacy and tolerability of Muscle Relaxants for low back pain systematic review and meta analysis
European Journal of Pain, 2017Co-Authors: Abdel C Shaheed, Christopher G Maher, Kylie A Williams, Andrew J MclachlanAbstract:Muscle Relaxants are commonly prescribed for low back pain (LBP); however, there is limited evidence of their clinical efficacy and tolerability. This review evaluated the efficacy and tolerability of Muscle Relaxants in people with LBP. We searched online databases including Medline, EMBASE, CENTRAL and PsycINFO (inception to end October 2015) and performed citation tracking for eligible randomized controlled trials (RCTs). Two authors independently extracted data and assessed risk of bias of randomized controlled trials of Muscle Relaxants. Pain outcomes were converted to a common 0–100 scale. Data were pooled using a random effects model with strength of evidence assessed using GRADE. Fifteen trials (3362 participants) were evaluated in this review. A total of five trials (496 participants) provide high quality evidence that Muscle Relaxants provide clinically significant pain relief in the short term for acute LBP; MD −21.3, [−29.0, −13.5]. There was no information on long-term outcomes. The median adverse event rate in clinical trials for Muscle Relaxants was similar to placebo 14.1% IQR (7.0–28.7%) and 16.0% (4.1–31.2%); p = 0.5, respectively. There is no evidence for the efficacy of benzodiazepines in LBP. For people with acute LBP, Muscle Relaxants provide clinically significant short-term pain relief. For chronic LBP, the efficacy of Muscle Relaxants is largely unknown. There was no eligible RCT evidence to support the efficacy of benzodiazepines in LBP. Prolonged use of these medicines in LBP cannot be guided by trial evidence. What does this review add? Muscle Relaxants provide clinically significant pain relief for acute low back pain. Caution must be taken with the interpretation of the findings as the evidence comes from specific Muscle relaxant medicines.
Hong Wang - One of the best experts on this subject based on the ideXlab platform.
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potency of nondepolarizing Muscle Relaxants on Muscle type acetylcholine receptors in denervated mouse skeletal Muscle
Acta Pharmacologica Sinica, 2010Co-Authors: Hong Wang, Bin Yang, Guangwei HanAbstract:To investigate the changing resistance to nondepolarizing Muscle Relaxants (NDMRs) during the first month after denervation. The denervated and innervated skeletal Muscle cells were examined on days 1, 4, 7, 14, 21, and 28 after denervation. Individual denervated and innervated cells were prepared from the flexor digitorum brevis of the surgically denervated and contralateral hind feet, respectively. Nicotinic acetylcholine receptors (nAChRs) in the cells were activated with 30 μmol/L acetylcholine, either alone or in combination with various concentrations of vecuronium. Currents were recorded using a whole-cell patch-clamp technique. The concentrations of vecuronium resulting in half-maximal inhibitory responses (IC50) increased 1.2- (P>0.05), 1.7-, 3.7-, 2.5-, 1.9-, and 1.8-fold (P<0.05) at Days 1, 4, 7, 14, 21, and 28 after denervation, respectively, compared to the innervated control. Resistance to vecuronium appeared at Day 4, peaked at Day 7, and declined at Day 14 after denervation. Nevertheless, IC50 values at Day 28 remained significantly higher than those for the innervated control, suggesting that the resistance to vecuronium had not disappeared at Day 28. The NDMR doses required to achieve satisfactory clinical effects differ at different times after Muscle denervation.
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different magnitude of resistance to nondepolarizing Muscle Relaxants in the denervated mouse skeletal Muscle
Acta Pharmacologica Sinica, 2010Co-Authors: Hong Wang, Bin Yang, Tao YanAbstract:Different magnitude of resistance to nondepolarizing Muscle Relaxants in the denervated mouse skeletal Muscle
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The effect of local anesthetics on the inhibition of adult Muscle-type nicotinic acetylcholine receptors by nondepolarizing Muscle Relaxants.
European journal of pharmacology, 2010Co-Authors: Hong Wang, Ying Zhang, Shi-tong LiAbstract:The primary action of local anesthetics is to inhibit voltage-gated Na(+) channels. However, local anesthetics also have an inhibitory effect on Muscle-type nicotinic acetylcholine receptors. Because local anesthetics could increase the neuromuscular blockade produced by nondepolarizing Muscle Relaxants, we investigated the interaction of local anesthetics with nondepolarizing Muscle Relaxants at adult Muscle-type nicotinic acetylcholine receptors. This study tested the effects of lidocaine and procaine, alone and in combination with vecuronium and cisatracurium, on adult Muscle-type nicotinic acetylcholine receptors. The adult mouse Muscle-type nicotinic acetylcholine receptor was expressed in HEK293 cells and activated with 10microM acetylcholine. Currents were recorded using the whole-cell voltage-clamp technique. Adult Muscle-type nicotinic acetylcholine receptors were potently inhibited by all the tested compounds. Although the potencies of procaine and lidocaine were statistically significantly different at adult Muscle-type nicotinic acetylcholine receptors (50% inhibitory concentration values of 45.5microM and 11.1microM, respectively), procaine and lidocaine enhanced the inhibitory effect of nondepolarizing Muscle Relaxants at adult Muscle-type nicotinic acetylcholine receptors to the same extent. The increased adult Muscle-type nicotinic acetylcholine receptor inhibition produced when local anesthetics are combined with nondepolarizing Muscle Relaxants may contribute to the clinical enhancement of neuromuscular blockade by local anesthetics.
Maurits W Van Tulder - One of the best experts on this subject based on the ideXlab platform.
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Muscle Relaxants for non specific low back pain
Cochrane Database of Systematic Reviews, 2003Co-Authors: Maurits W Van Tulder, Andrea D Furlan, Tony Touray, Sherra Solway, L M BouterAbstract:Background The use of Muscle Relaxants in the management of non-specific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. Objectives The aim of this review was to determine if Muscle Relaxants are effective in the treatment of non-specific low back pain. Search methods A computer-assisted search of the Cochrane Library (Issue 3, 2002), MEDLINE (1966 up to October 2002) and EMBASE (1988 up to October 2002) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Selection criteria Randomised and/or double-blinded controlled trials, involving patients diagnosed with non-specific low back pain, treated with Muscle Relaxants as monotherapy or in combination with other therapeutic modalities, were included for review. Data collection and analysis Two authors independently carried out the methodological quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong", "moderate", "limited", "conflicting" or "no" evidence. Main results Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality, 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 non-benzodiazepines and two antispasticity Muscle Relaxants in comparison with placebo. Results showed that there is strong evidence that any of these Muscle Relaxants are more effective than placebo for patients with acute LBP on short-term pain relief. The pooled RR for non-benzodiazepines versus placebo after two to four days was 0.80 [95% CI; 0.71 to 0.89] for pain relief and 0.49 [95% CI; 0.25 to 0.95] for global efficacy. Adverse events, however, with a relative risk of 1.50 [95% CI; 1.14 to 1.98] were significantly more prevalent in patients receiving Muscle Relaxants and especially the central nervous system adverse effects (RR 2.04; 95% CI; 1.23 to 3.37). The various Muscle Relaxants were found to be similar in performance. Authors' conclusions Muscle Relaxants are effective in the management of non-specific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if Muscle Relaxants are more effective than analgesics or non-steroidal anti-inflammatory drugs.
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Muscle Relaxants for nonspecific low back pain a systematic review within the framework of the cochrane collaboration
Spine, 2003Co-Authors: Maurits W Van Tulder, Andrea D Furlan, Tony Touray, Sherra Solway, L M BouterAbstract:STUDY DESIGN: A systematic review of randomized and/or double-blinded controlled trials. SUMMARY OF BACKGROUND DATA: The use of Muscle Relaxants in the management of nonspecific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. OBJECTIVES: The aim of this review was to determine if Muscle Relaxants are effective in the treatment of nonspecific low back pain. METHODS: A computer-assisted search of the Cochrane Library (Issue 2, 2002), MEDLINE (1966 up to October 2001), and EMBASE (1988 up to October 2001) was carried out. These databases were searched using the algorithm recommended by the Cochrane Back Review Group. References cited in the identified articles and other relevant literature were screened. Randomized and/or double-blinded controlled trials, involving patients diagnosed with nonspecific low back pain, treated with Muscle Relaxants as monotherapy or in combination with other therapeutic methods, were included for review. Two reviewers independently carried out the methodologic quality assessment and data extraction of the trials. The analysis comprised not only a quantitative analysis (statistical pooling) but also a qualitative analysis ("best evidence synthesis"). This involved the appraisal of the strength of evidence for various conclusions using a rating system based on the quality and outcomes of the studies included. Evidence was classified as "strong," "moderate," "limited," "conflicting," or "no" evidence. RESULTS: Thirty trials met the inclusion criteria. Twenty-three trials (77%) were of high quality; 24 trials (80%) were on acute low back pain. Four trials studied benzodiazepines, 11 nonbenzodiazepines, and 2 antispasticity Muscle Relaxants in comparison with placebo. Results showed that there is strong evidence that any of these Muscle Relaxants are more effective than placebo for patients with acute low back pain on short-term pain relief. The pooled relative risk for nonbenzodiazepines versus placebo after 2 to 4 days was 0.80 (95% confidence interval: 0.71 to 0.89) for pain relief and 0.49 (95% confidence interval: 0.25 to 0.95) for global efficacy. Adverse events, however, with a relative risk of 1.50 (95% confidence interval: 1.14 to 1.98) were significantly more prevalent in patients receiving Muscle Relaxants and especially the central nervous system adverse effects (relative risk 2.04; 95% confidence interval: 1.23 to 3.37). The various Muscle Relaxants were found to be similar in performance. CONCLUSIONS: Muscle Relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if Muscle Relaxants are more effective than analgesics or nonsteroidal anti-inflammatory drugs
Jerry Paul - One of the best experts on this subject based on the ideXlab platform.
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Comparison of efficacy and safety of dexmedetomidine versus propofol infusion for maintaining depth of general anesthesia when Muscle Relaxants are not used
'Medknow', 2020Co-Authors: Pulak Tosh, Sunil Rajan, Naina Narayani, Karthik Chandra Babu, Niranjan Kumar, Jerry PaulAbstract:Background: In surgeries where direct nerve stimulation is required intraoperatively, the use of long-acting Muscle Relaxants should be avoided. The study aimed to assess the efficacy of dexmedetomidine versus propofol infusion in providing an adequate depth of general anesthesia where long-acting Muscle Relaxants were not used intraoperatively and to compare hemodynamics in both the groups. Patients and Methods: It was a prospective randomized controlled study done in forty patients undergoing total parotidectomy or brachial plexus surgeries. Group D received an intravenous (IV) bolus of dexmedetomidine 1 mcg/kg body weight before induction, followed by infusion at 0.7 mcg/kg/h intraoperatively. In Group B, the infusion of propofol was started at a rate of 1.5 mg/kg/h to a maximum of 100 mg/h after intubation. In both the groups, if the patient moved, bucked on the endotracheal tube, or if there were signs of inadequate depth of anesthesia, a bolus of propofol 0.5 mg/kg IV was given and repeated as required. Statistical analysis was performed using Mann–Whitney U-test and Fisher's exact test. Results: The number of times propofol bolus was required intraoperatively did not show any significant difference between groups. The mean heart rate was significantly lower in Group D before induction. At any other time points, the mean systolic blood pressure and mean arterial blood pressure were comparable in both the groups. Conclusion: Both dexmedetomidine and propofol infusions are equally effective and safe in providing an adequate depth of general anesthesia as reflected by patient immobility during surgeries where long-acting Muscle Relaxants were not used
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evaluation of endotracheal intubating conditions without the use of Muscle Relaxants following induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries
Journal of Anaesthesiology Clinical Pharmacology, 2014Co-Authors: Sunil Rajan, Priyanka Gotluru, Susamma Andews, Jerry PaulAbstract:Background and Aims: Children with facial clefts are usually difficult to intubate and it is considered safer to keep them spontaneously breathing while securing the airway. This prospective comparative study was conducted to evaluate endotracheal intubating conditions in pediatric patients undergoing cleft surgeries, without the use of Muscle Relaxants following induction with propofol and sevoflurane. Materials and Methods: Sixty patients aged 1month to 3 years, were randomly allocated into two equal groups. Anesthesia was induced with sevoflurane 8% in oxygen in group 1 and with propofol 3 mg/kg in group 2. Laryngoscopy and intubation were attempted 150 s after induction in both groups and ease of laryngoscopy, position of vocal cords, degree of coughing, jaw relaxation, and limb movements were assessed and scored. Total score of 5 was considered excellent, 6-10 good, 11-15 poor, and 16-20 bad. Total score ≤ 10 was considered clinically acceptable, and >10 as clinically unacceptable. Chi-square and Wilcoxon Mann-Whitney tests were used to analyze data. Results: There was no significant difference between groups when ease of laryngoscopy was compared. Sevoflurane induced patients had significantly better position of vocal cords at intubation and the propofol group had significantly more episodes of coughing. Significantly less number of patients had limb movements in sevoflurane group. There was no significant difference in degree of jaw relaxation between groups. The sevoflurane group had significantly better total scores and clinically acceptable intubating conditions. Conclusion: Sevoflurane 8% in oxygen provides clinically acceptable intubating conditions without use of Muscle Relaxants in pediatric cleft patients.
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transtracheal lidocaine an alternative to intraoperative propofol infusion when Muscle Relaxants are not used
Journal of Anaesthesiology Clinical Pharmacology, 2014Co-Authors: Sunil Rajan, Nitu Puthenveettil, Jerry PaulAbstract:Background: Facial nerve monitoring, often required during total parotidectomy, precludes use of long acting Muscle Relaxants and propofol infusion is used solely to ensure patient immobility. We aimed to compare intraoperative patient immobility, hemodynamic stability and propofol consumption during total parotidectomy following a transtracheal block. Material and Methods: Forty patients were allocated to 2 equal groups. Preoperatively, group A patients received transtracheal block with 4 ml of 4% lidocaine, while no block was given to patients in group B. If there was patient movement, tachycardia or hypertension, group A patients received a bolus of propofol 30 mg and propofol infusion was started (100mg/hr). In group B, propofol infusion was started (100mg/hr) soon after intubation. Result: Both group A and B were comparable with respect to patient immobility and hemodynamic stability. There was no intraoperative propofol requirement in group A. Conclusion: Transtracheal block is a safe and successful alternative to propofol infusion during surgeries where Muscle Relaxants are to be avoided.
