Postoperative analgesia by intraarticular clonidine and neostigmine in patients undergoing knee arthroscopy

Gentili, Marc; Enel, Dominique; Szymskiewicz, Olga; Mansour, Fatima; Bonnet, Francis

doi:10.1053/rapm.2001.23461

Cited by 14 publications

(4 citation statements)

References 25 publications

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“…Drug release per day was <150 µg after 24 hours (the typical dose in orthopedic postoperative pain studies) ( Figure 5 ). 15 – 17 Expressed as HED, the rate of drug release falls below the recommended starting dose for epidural administration (30 µg/hour in man) by 6 hours (per biphasic nonlinear regression model, Figure 5 ).…”

Section: Resultsmentioning

confidence: 99%

“…However, accumulating evidence demonstrates distinct, peripherally mediated actions that could contribute to analgesia. Intra-articular or periarticular administration of 150 mg clonidine has been shown to provide an analgesic effect following arthroscopic knee 15 – 17 , 22 and shoulder surgery. 18 Consistent with a local mechanism of action, subcutaneous administration of the same dose had no effect on postoperative pain or consumption of rescue medication.…”

Section: Discussionmentioning

confidence: 99%

“… 12 – 14 Local, perioperative administration of 150 µg clonidine HCl has been shown to reduce the pain associated with orthopedic surgery. This dose of clonidine was effective when injected into the intra-articular space during arthroscopic knee surgery 15 – 17 or when injected into neighboring muscle tissue during arthroscopic shoulder surgery. 18 Consistent with a local mechanism of action, subcutaneous administration of the same dose was ineffective in both studies.…”

Section: Introductionmentioning

confidence: 99%

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Sustained analgesic effect of clonidine co-polymer depot in a porcine incisional pain model

Wilsey¹,

Block²

2018

JPR

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BackgroundPrevious research suggests that the α2 adrenergic agonist clonidine, a centrally acting analgesic and antihypertensive, may also have direct effects on peripheral pain generators. However, aqueous injections are limited by rapid systemic absorption leading to off target effects and a brief analgesic duration of action.PurposeThe aim of this study was to examine the efficacy of a sustained-release clonidine depot, placed in the wound bed, in a pig incisional pain model.MethodsThe depot was a 15 mm ×5 mm ×0.3 mm poly(lactide-co-caprolactone) polymer film containing 3% (w/w) clonidine HCl (MDT3). Fifty-two young adult mix Landrace pigs (9–11 kg) were divided into seven groups. All subjects received a 6 cm, full-thickness, linear incision into the left lateral flank. Group 1 served as a Sham control group (Sham, n=8). Group 2 received three placebo strips (PBO, n=8), placed end-to-end in the subcutaneous wound bed before wound closure. Group 3 received one MDT3 and two PBO (n=8), Group 4 received two MDT3 and one PBO (n=8), and Group 5 received three MDT3 (n=8). Positive control groups received peri-incisional injections of bupivacaine solution (Group 6, 30 mg/day bupivacaine, n=8) or clonidine solution (Group 7, 225 µg/day, n=4).ResultsThe surgical procedure was associated with significant peri-incisional tactile allodynia. There was a dose-dependent effect of MDT3 in partially reversing the peri-incisional tactile allodynia, with maximum pain relief relative to Sham at 72 hours. Daily injections of bupivacaine (30 mg), but not clonidine (up to 225 µg), completely reversed allodynia within 48 hours. There was a statistically significant correlation between the dose of MDT3 and cumulative withdrawal threshold from 4 hours through the conclusion of the study on day 7.ConclusionThese data suggest that a sustained-release clonidine depot may be a viable nonopioid, nonamide anesthetic therapy for the treatment of acute postsurgical nociceptive sensitization.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sustained analgesic effect of clonidine co-polymer depot in a porcine incisional pain model

Wilsey¹,

Block²

2018

JPR

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“…The dosage of 10 mg morphine and 100 μg clonidine was chosen based on previous literature demonstrating the effectiveness of such doses for postoperative pain management in arthroscopic knee surgery while also considering the larger size of the hip joint as compared with the knee. 3 , 6 , 8 …”

Section: Methodsmentioning

confidence: 99%

Assessment of Intraoperative Intra-articular Morphine and Clonidine Injection in the Acute Postoperative Period After Hip Arthroscopy

Cogan

Knesek

Tjong

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Previous authors have suggested that intra-articular morphine and clonidine injections after knee arthroscopy have demonstrated equivocal analgesic effect in comparison with bupivacaine while circumventing the issue of chondrotoxicity. There have been no studies evaluating the effect of intra-articular morphine after hip arthroscopy.Purpose:To evaluate the efficacy of intra-articular morphine in combination with clonidine on postoperative pain and narcotic consumption after hip arthroscopy surgery for femoroacetabular impingement.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was performed on 43 patients that underwent hip arthroscopy for femoroacetabular impingement at a single institution between September 2014 and May 2015. All patients received preoperative celecoxib and acetaminophen, and 22 patients received an additional intra-articular injection of 10 mg morphine and 100 μg of clonidine at the conclusion of the procedure. Narcotic consumption, duration of anesthesia recovery, and perioperative pain scores were compared between the 2 groups.Results:Patients who received intra-articular morphine and clonidine used significantly less opioid analgesic (mEq) in the postanesthesia recovery (median difference, 17 mEq [95% CI, –32 to –2 mEq]; P = .02) compared with the control group. There were no differences in time spent in recovery before hospital discharge or in visual analog pain scores recorded immediately postoperatively and at 1 hour after surgery.Conclusion:Intraoperative intra-articular injection of morphine and clonidine significantly reduced the narcotic requirement during the postsurgical recovery period after hip arthroscopy. The reduction in postsurgical opioids may decrease adverse effects, improve overall pain management, and lead to better quality of recovery and improved patient satisfaction.

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Drugs for preventing postoperative nausea and vomiting

Carlisle

Stevenson²

2017

Cochrane Database of Systematic Reviews

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Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.

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Postoperative analgesia by intraarticular clonidine and neostigmine in patients undergoing knee arthroscopy

Abstract: Intraarticular administration of 150 microg of clonidine, 500 microg of neostigmine, or both produce postoperative analgesia, and the combination is not more effective.

Cited by 14 publications

References 25 publications

Sustained analgesic effect of clonidine co-polymer depot in a porcine incisional pain model

Sustained analgesic effect of clonidine co-polymer depot in a porcine incisional pain model

Assessment of Intraoperative Intra-articular Morphine and Clonidine Injection in the Acute Postoperative Period After Hip Arthroscopy

Drugs for preventing postoperative nausea and vomiting

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