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Online ISSN 1827-1707
Federica ROSSO, Roberto ROSSI
Unit of Orthopedics and Traumatology, Mauriziano Umberto I Hospital, Turin, Italy
Total knee arthroscopy (TKA) is associated with considerable postsurgical pain, which can negatively impact on rehabilitation outcome. There is growing interest in developing analgesia protocols that are more effective in controlling pain while reducing side effects. Postsurgical pain partly originates from the spasm-pain-spasm cycle which, in turn, is linked to polysynaptic circuits. Muscle relaxants, because they can contribute to breaking this cycle, may find use in the control of postsurgical pain. Eperisone hy-drochloride (4-ethyl-2-methyl-piperidinopro-piophenone chloride), a centrally acting muscle relaxant and recently developed derivative of aminopropiophenone, has been demonstrated to be effective in the treatment of chronic pain of muscular origin (i.e., low back pain) and associated with fewer side effects than other centrally acting muscle relaxants. Eperisone hydrochloride has several mechanisms of action: skeletal muscle relaxation; hemodynamic action; and analgesic activity. It may be useful in breaking the spasm-pain-spasm cycle which contributes to postsurgical pain, particularly following TKA, in which rehabilitation and muscle contraction play an essential role. This article discusses the genesis of postsurgical pain, the role the spasm-pain-spasm cycle plays in causing pain, and the function of muscle relaxants in pain treatment. Specifically, the discussion centers on eperisone hydrochloride, its mechanisms of action, tolerability profile, effectiveness, and rationale for its use as an adjuvant in the treatment of postsurgical pain.