HOUSTON - s4story -- Intravenous methocarbamol (Robaxin), a skeletal muscle relaxant frequently used to manage pain after spine surgery, may not reduce acute pain or opioid consumption, according to a new study published in Regional Anesthesia & Pain Medicine, the premier peer-reviewed journal for acute pain management. The study's findings suggest that the routine use of intravenous methocarbamol in postoperative multimodal analgesia protocols may not be warranted.

More than 1.2 million spine surgeries are performed in the U.S. annually, and managing the significant postoperative pain associated with these procedures is a major clinical challenge. While skeletal muscle relaxants are often included in pain management regimens, evidence supporting their effectiveness has been limited and inconsistent.

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To clarify the drug's role, researchers conducted a robust target trial emulation, a rigorous observational study method designed to mirror a randomized clinical. They analyzed electronic health record data from 1,270 adult patients undergoing elective spine surgery between 2020 and 2023. The study compared patients who received at least 500 mg of intravenous methocarbamol within two hours of surgery to those who received usual care without the muscle relaxant.

The primary outcomes were the time-weighted average pain score and cumulative opioid consumption during the first six hours after treatment. The analysis revealed no significant difference between the two groups on either measure. The adjusted mean difference in pain scores was a negligible 0.1 on a 10-point scale, and there was no reduction in opioid use. These results were consistent across several sensitivity analyses.

These findings challenge the routine administration of intravenous methocarbamol after spine surgery. The study's authors note that eliminating an ineffective medication could help reduce polypharmacy, a practice that poses risks, particularly for older adults. The American Geriatrics Society Beers Criteria® lists muscle relaxants as potentially inappropriate for older adults due to increased risks of sedation and falls. While the study suggests against routine use of IV methocarbamol for acute postoperative pain after spine surgery, the authors note it may still hold value for a targeted subset of patients who exhibit clear signs of muscle spasm.

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Citation: Potnuru, P., Baranov, A., Khudirat, M., & Turan, A. (2025). Intravenous methocarbamol for acute pain after spine surgery: a target trial emulation. Regional Anesthesia & Pain Medicine, rapm-2025-107010. Advance online publication. https://doi.org/10.1136/rapm-2025-107010