Intraoperative clonidine enhances postoperative morphine patient-controlled analgesia

Abstract

In this prospective study, the postoperative analgesic effects of intraoperative iv clonidine were evaluated. Two hundred consecutive patients undergoing major abdominal surgery were randomly assigned to either balanced anaesthesia with iv clonidine (Group 1) 55,4 +--30,6 mg versus 67,1 +_ 45,1 mg dans le groupe 2 (P < 0,05); cette diffgrence est plus marquee dans les 12 premiOres heures aprks la chirurgie (19,7 --+ 11,1 mg versus 27,6 +--18,1 mg;P < 0,001 Adequate postoperative analgesia has become a priority. Besides providing patient comfort, it reduces the incidence of complications and the length of hospitalization.I Despite the progress of technology, the exclusive management of pain by epidural or parenteral opiates cannot be achieved without close surveillance or complications. 2 Kehlet recently introduced the concept of postoperative "balanced analgesia" using, among other drugs, opiates, CAN J ANAESTH 1992 / 39:6 / pp 537-44

Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements

“…One explanation for prolonged postoperative analgesia with dexmedetomidine may be the anxiolytic and thymoanaleptic properties of α 2 -agonists, which act on the emotional component of postoperative pain. 24 In summary, our results indicate that intraoperatively administered dexmedetomidine has specific analgesic properties and provides effective visceral pain relief. We found that continuous infusion of dexmedetomidine during abdominal surgery significantly reduces the amount of PCA morphine that patients require to remain comfortable postoperatively, without affecting time to extubation.…”

Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity

“…1-3, which are individual Forest plots). 18,20,21,24,26,29,33,37,38,43 At 2 h after surgery, the median of all average cumulative morphine equivalents in control subjects was 12.2 mg (range, 7.0 -17.3); clonidine did not significantly decrease this amount. 33,37 At 12 h, the median of the average cumulative morphine-equivalents in controls was 30.1 mg (range, 10.8 -36.0), and clonidine showed a significant morphine-sparing effect (WMD Ϫ9.8 mg).…”

“…33,37 At 12 h, the median of the average cumulative morphine-equivalents in controls was 30.1 mg (range, 10.8 -36.0), and clonidine showed a significant morphine-sparing effect (WMD Ϫ9.8 mg). 18,20,24,26 At 24 h, the median of the average cumulative morphine equivalents in controls was 16.7 mg (range, 11.0 -49.9), and clonidine significantly decreased this amount (WMD Ϫ4.1 mg). 21,29,38,43 Data on cumulative consumption of morphine equivalents could be combined from eight trials that tested dexmedetomidine ( fig.…”

“…Recovery Times. Time to extubation was reported in five trials, 16,20,30,39,40 time to spontaneous eye opening in four, 25,30,36,39 and time to response to verbal command in nine ( 16,19,25,28,30,34,35,39,40 In dexmedetomidine trials, the median of all average times to extubation in control subjects was 7.0 min (range, 5.7-7.5). Dexmedetomidine significantly shortened that time (WMD Ϫ1.6 min).…”

Innovations in Pain Management: Morphine Combined with Omega-3 Fatty Acids

“…Adjuncts to opioid therapy include nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) [55], acetaminophen [56], antiarrhythmics, anticonvulsants [57], antidepressants (such as desipramine) [58], antipsychotics, baclofen, benzodiazepines, capsaicin, calcium channel blockers, clonidine hydrochloride [59], central nervous system stimulants, corticosteroids, local anesthetics, N-methyl-D-aspartate receptor antagonists and scopolamine [60,61]. Of these, some (e.g., acetaminophen) are currently routinely used, whereas others (e.g., nifedipine [calcium channel blocker]) are only administered on a limited basis.…”