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Epidural Clonidine Decreases Postoperative Requirements for Epidural Fentanyl
  1. L. Delaunay, M.D.,
  2. N. Liu, M.D.,
  3. C. Leppert, M.D.,
  4. F. Bonnet, M.D.,
  5. V. Dechaubry, M.D. and
  6. J. C. Levron, M.D.
  1. From the Service d'Anesthésie Réanimation, Hôpital Henri Mondor, Créteil, France.
  1. Address correspondence and reprint requests to F. Bonnet, M.D., Département d'Anesthésie Réanimation, Hôpital Henri Mondor, 51, avenue Maréchal de Lattre de Tassigny, 94010 Créteil, France.


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 (1.0−1) followed by a 1.0−1h−1 continuous epidural infusion, or an epidural bolus dose of fentanyl (1.0−1) followed by a continuous epidural infusion combining fentanyl 0.5−1.h−1 and clonidine 0.3−1.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.

  • Analgesia
  • postoperative
  • analgesics
  • opioids
  • fentanyl
  • Anesthetic technique
  • epidural
  • Interactions
  • epidural
  • morphine—clonidine
  • Pain
  • postoperative
  • Sympathetic nervous system
  • a2 adrenergic agonist
  • clonidine.

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