Table 5. Review studies of different muscle relaxants and their role in multimodal analgesia.

AE: adverse effect

Medication or class	Author	Recommended use	Contraindications and/or specific recommendations
Methocarbamol	Looke & Kluth 2013 [15], Patanwala et al. 2017 [7]	Muscle spasms, hip and knee replacements, trauma, and rib fractures	Renal impairment, methocarbamol is less sedating, has less psychological dependence potential, and has less significant withdrawal potential than other agents.
Cyclobenzaprine	Khwaja et al. 2010 [24]	Muscle spasms	AEs: cardiac arrhythmias, sedation, dizziness
Carisoprodol	Serfer et al. 2010 [25]	Muscle spasms	AEs: barbiturate-like effects
Baclofen	Pérez-Arredondo et al. 2016 [26]	Spasticity, spasticity with brain or spinal cord injuries	AEs: sedation, serious withdrawal (seizures), renal impairment
Tizanidine	Yazicioglu et al. 2016 [27]	Spasticity, muscle spasms	AEs: hepatotoxicity, withdrawal, renal impairment
Zolpidem	Hagan et al. 2020 [28]	Spasticity, muscle spasms	Benzodiazepines like effects
Ketamine	Patanwala et al. 2017 [29]	Severe post-operative pain, opioid tolerance, opioid-induced hyperalgesia, opioid-induced respiratory depression	AEs: hypersalivation, laryngospasm, hallucinations precautions; severe CV disease, pregnancy, active psychosis, elderly
Local and/or regional anesthesia	Choi et al. 2013 [30]	Perioperative pain management, rib or hip fracture	AEs: nerve injury, hypotension, hematoma relative contraindication; compartment syndrome, coagulopathy