Efficacy of Muscle Relaxants on a Multimodal Analgesic Regimen in Total Knee Arthroplasty: A Prospective, Double-Blind, Placebo-Controlled, Randomized Trial.

BACKGROUND

Postoperative muscle spasms markedly contribute to acute pain and restricted joint mobility after primary total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding muscle relaxants as an adjunctive therapy in multimodal analgesic protocols for post-TKA pain management.

METHODS

In this randomized trial with a 30-day follow-up, 120 patients undergoing TKA were assigned to receive either tizanidine (two mg three times daily for 14 days, starting on the first postoperative day) or placebo. The tizanidine group (n = 58) and placebo group (n = 56) had comparable baseline characteristics and surgical details (P > 0.05). Primary outcome was postoperative pain intensity, measured using the visual analog scale. Secondary outcomes included knee range of motion (ROM), Hospital for Special Surgery score, morphine consumption during hospitalization, serum levels of inflammatory biomarkers (C-reactive protein and interleukin-6), and complications.

RESULTS

Tizanidine significantly reduced visual analog scale pain scores during ambulation on postoperative days three (mean difference: -1.56, P < 0.001), seven (mean difference: -2.40, P < 0.001), and 14 (mean difference: -1.47, P < 0.001), decreased the morphine prescription rate (24.1 versus 42.9%, P = 0.034), and improved knee ROM on day three (mean difference: 8.7°, P = 0.012) and day seven (mean difference: 6.7°, P = 0.038). Transient somnolence was significantly more frequent in the tizanidine group (20.7 versus 3.6%, P = 0.015). There were no significant intergroup differences observed in inflammatory biomarkers, resting pain scores, or Hospital for Special Surgery scores.

CONCLUSIONS

Adding tizanidine to multimodal analgesia protocols provided clinically meaningful postoperative pain relief during ambulation, reduced the morphine prescription rate, and enhanced knee ROM recovery. These results may offer important implications for optimizing postoperative pain management strategies and inform future clinical practice guidelines for TKA recovery protocols.