Objective. This study assesses the possibility that clonidine may decrease analgesic opioid demand in postoperative patients.
Methods. Twenty-five patients were allocated randomly after abdominal surgery to receive either an epidural bolus dose of fentanyl (1.0 mcg.kg−1) followed by a 1.0 mcg.kg−1h−1 continuous epidural infusion, or an epidural bolus dose of fentanyl (1.0 mcg.kg−1) followed by a continuous epidural infusion combining fentanyl 0.5 mcg.kg−1.h−1 and clonidine 0.3 mcg.kg−1.h−1. Pain was assessed at definite intervals on a visual analog scale (VAS) over 3 postoperative days. Epidural infusion was halved when VAS score was lower than 2. Patients were monitored with a pulse oxymeter over 12 hours during the first postoperative night. Plasma fentanyl was measured by radioimmunoassay when patients left the recovery room and at 8 a.m. on the first and the second postoperative days.
Results. VAS scores were comparable in the two groups of patients. The amount of fentanyl delivered was significantly lower in the fentanyl + clonidine group, as were the plasma fentanyl concentrations. The duration of SaO2 < 90% episodes was significantly less prolonged in the fentanyl + clonidine group (3.5 ± 4.8 minutes versus 14.4 ± 14.6 minutes).
Conclusions. The combination of clonidine to epidural fentanyl allows a decrease in opioid requirements without impairing analgesia. Reduction of opioids administration may have beneficial effects on respiratory function in postoperative patients.
- Anesthetic technique
- Sympathetic nervous system
- a2 adrenergic agonist
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