Clonidine as an Adjuvant to Intrathecal Local Anesthetics for Surgery: Systematic Review of Randomized Trials

Elia, Nadia; Culebras, Xavier; Mazza, Christian; Schiffer, Eduardo; Tramèr, Martin R.

doi:10.1016/j.rapm.2007.10.008

Cited by 129 publications

(153 citation statements)

References 30 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Meta-analysis with data from independent trials is not a particularly sensitive tool to identify a dose-response relationship if there is one. The same dilemma has been shown in a similar setting before [26]. It cannot be excluded that dose responsiveness was hidden by confounding factors (eg, type of surgery, concomitant usage of nonopioid analgesics).…”

Section: Lack Of Dose Responsivenessmentioning

confidence: 67%

See 1 more Smart Citation

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Pöpping

Elia

Marret

et al. 2012

Pain

View full text Add to dashboard Cite

a b s t r a c tOpioids are widely used as additives to local anesthetics for intrathecal anesthesia. Benefit and risk remain unclear. We systematically searched databases and bibliographies to February 2011 for full reports of randomized comparisons of any opioid added to any intrathecal local anesthetic with the local anesthetic alone in adults undergoing surgery (except cesarean section) and receiving single-shot intrathecal anesthesia without general anesthesia. We included 65 trials (3338 patients, 1932 of whom received opioids) published between 1983 and 2010. Morphine (0.05-2 mg) and fentanyl (10-50 lg) added to bupivacaine were the most frequently tested. Duration of postoperative analgesia was prolonged with morphine (weighted mean difference 503 min; 95% confidence interval [CI] 315 to 641) and fentanyl (weighted mean difference 114 min; 95% CI 60 to 168). Morphine decreased the number of patients needing opioid analgesia after surgery and decreased pain intensity to the 12th postoperative hour. Morphine increased the risk of nausea (number needed to harm [NNH] 9.9), vomiting (NNH 10), urinary retention (NNH 6.5), and pruritus (NNH 4.4). Fentanyl increased the risk of pruritus (NNH 3.3). With morphine 0.05 to 0.5 mg, the NNH for respiratory depression varied between 38 and 59 depending on the definition of respiratory depression chosen. With fentanyl 10 to 40 lg, the risk of respiratory depression was not significantly increased. For none of these effects, beneficial or harmful, was there evidence of dose-responsiveness. Consequently, minimal effective doses of intrathecal morphine and fentanyl should be sought. For intrathecal buprenorphine, diamorphine, hydromorphone, meperidine, methadone, pentazocine, sufentanil, and tramadol, there were not enough data to allow for meaningful conclusions.Ó

show abstract

Section: Lack Of Dose Responsivenessmentioning

confidence: 67%

“…As in previous similar analyses, there was an arbitrary pre hoc decision that meta-analysis was considered worthwhile when data from at least 5 trials or at least 100 patients could be combined [26].…”

Section: Analysesmentioning

confidence: 99%

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Pöpping

Elia

Marret

et al. 2012

Pain

View full text Add to dashboard Cite

show abstract

“…22 In motor parameters, mean time for onset of motor block (Bromage 3) was 12.88 ± 4.51 mins for Group C and 8.25 ± 3.11 mins in Group D. There is decrease in onset time of motor block after adding dexmedetomidine as compared to clonidine as measured by Bromage scale. 26 Difference was significant (p<0.05) when both groups were compared. These results were in concordance to the studies by Singh et al and Halder et al, while Kanazi et al found that the onset of motor block was faster for clonidine group (11.7 ± 5.9 mins) as compared to dexmedetomidine group.…”

Section: Discussionmentioning

confidence: 90%

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Chandra¹,

Krishna

Singh

2017

Int Surg J

View full text Add to dashboard Cite

Background: Spinal anaesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s wellbeing, while motor block facilitates the surgeon’s work. Post-operative pain relief can be achieved by various methods namely systemic opioid and non-opioid peripheral nerve blocks and local wound infiltration, each with their own merits and demerits. the present study was undertaken to compare the effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia.Methods: 80 patients between 20-60 years, undergoing elective surgery for closed fracture shaft of femur and tibia with ASA physical status of 1 and 2 were included in the study. All the subjects were randomly allocated to one of the two groups (Group C and Group D) by a computer-generated randomization chart. Group C received 2.5ml of 0.5% hyperbaric bupivacaine with 50mcg clonidine and group D received 2.5ml of 0.5% hyperbaric bupivacaine with 5mcg dexmedetomidine.Results: 30 of the 40 patients in group C were of ASA I and 10 were ASA II, while in group D, 25 were ASA I and 15 were ASA II. A significant difference was found in the onset time for sensory and motor block, receding time for sensory and motor block and the need of the first rescue analgesia between the two groups, showing that Dexmedetomidine was more potent than clonidine.Conclusions: Dexmedetomidine is a potent, highly selective and specific α2-adrenoreceptor agonist that has both sedative and analgesic effects and is also a valuable adjuvant when regional anaesthesia is incorporated.

show abstract

“…The prolongation of sensory and motor block may result from synergism between bupivacaine and clonidine. 3 Nalbuphine is highly lipid soluble synthetic opioid analgesic with agonist-antagonist activity. It acts as antagonist at µ-receptors and agonist at κ-receptors.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

et al. 2017

View full text Add to dashboard Cite

Background: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Methods: Regional anesthesia techniques for gynaecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for gynaecological procedures.Results: The onset of sensory block was earlier in patients of Group BN (3.91±2.25 min vs 4.30±0.87 min, p=0.039). The onset of motor block was also earlier in patients of Group BN (p=0.042). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed (283±14.18 min vs 231.50±26.18 min, p=0.001). Intraoperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression, shivering, nausea or vomiting.Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynaecological procedures.

show abstract

Clonidine as an Adjuvant to Intrathecal Local Anesthetics for Surgery: Systematic Review of Randomized Trials

Abstract: This study may serve as a rational basis to help clinicians decide whether or not to combine clonidine with an intrathecal local anesthetic for surgery. The optimal dose of clonidine, however, remains unknown.

Cited by 129 publications

References 30 publications

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Comparison of effect of intrathecal dexmedetomidine and clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing surgery for fracture femur and tibia

Clinical efficacy of clonidine versus nalbuphine as intrathecal adjuvants to 0.5% hyperbaric bupivacaine for subarachnoid block during gynaecological procedures: a double blind study

Contact Info

Product

Resources

About