Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: A systematic review and meta‐analysis

Abstract

Background Postoperative vomiting and pain are common, unpleasant phenomena in pediatric patients undergoing ophthalmic surgery. Clonidine has antiemetic and analgesic properties and thus may be used as premedication to reduce postoperative vomiting and pain. Aim To assess whether clonidine premedication may safely decrease postoperative vomiting and postoperative pain in pediatric patients who received an ophthalmic surgery. Methods We systematically searched PubMed, EMBASE, Cochrane Library, and Scopus databases from their inception to September 2018. Randomized clinical trials comparing clonidine premedication with a placebo or an active comparator that investigated postoperative vomiting or postoperative pain in pediatric patients undergoing ophthalmic surgery were included. The primary outcome was postoperative vomiting. The secondary outcome was postoperative pain. We also evaluated the safety of clonidine premedication by tracking hemodynamic instability associated with its use. Results Ten studies with 979 patients were eligible for inclusion. Clonidine achieved a significantly lower incidence of postoperative vomiting within 6 hours postoperatively, 6‐24 hours postoperatively, and at the end of the study (risk difference: −0.15; 95% confidence interval: −0.32 to −0.05; risk difference: −0.15; 95% confidence interval: −0.29 to 0.01; and risk difference: −0.23; 95% confidence interval: −0.34 to −0.12, respectively) than placebo. For the subgroup of patients who received strabismus surgery, clonidine produced a lower incidence of postoperative vomiting than placebo (risk difference: −0.19; 95% confidence interval: −0.29 to −0.05). Compared to benzodiazepine, clonidine achieved a lower incidence of postoperative vomiting at the end of the study (risk difference: −0.19; 95% confidence interval: −0.31 to −0.07); the effect was only observed in patients receiving clonidine 4 μg/kg. Furthermore, children receiving clonidine had lower postoperative pain scores, lower analgesic requirements, and more of them were pain‐free compared to those who received a placebo. No patient using clonidine had any major hemodynamic instability. Conclusion Compared to placebo or benzodiazepine, clonidine premedication was effective in reducing postoperative vomiting in pediatric patients undergoing ophthalmic surgery. Clonidine premedication also provided more reduction in postoperative pain when compared to placebo. The use of clonidine premedication was not associated with adverse hemodynamic events.

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

“…Our current findings suggested that dexmedetomidine reduces the number of patients requiring analgesia and the pain intensity among children undergoing strabismus surgery. This result is consistent with those of previous studies [36]. Therefore, our results may be crucial for updating clinical practice guidelines in the future.…”

“…In a 2016 guideline, ondansetron combined with dexamethasone-but not dexmedetomidine alonewas recommended to increase the effectiveness of PONV prevention in children scheduled for strabismus surgery [39]. In a 2019 meta-analysis [36], compared with placebo use, premedication with clonidine (another α2 agonist) decreased PONV incidence by 17% in children undergoing strabismus surgery, which is in agreement with our findings. Moreover, for PONV incidence, we found 0% heterogeneity and narrow CIs for its RR.…”

“…PONV, which is a common phenomenon in patients who have undergone pediatric strabismus surgery, can potentially led to considerable dehydration, electrolyte imbalance, aspiration pneumonia risk, delayed hospital discharge, and an increased number of unscheduled hospital admissions, all of which increase healthcare costs [35,36]. In their meta-analysis, Jin et al [37] reported that compared with placebo, dexmedetomidine had a more significant prophylactic antiemetic effect in both adult and pediatric patients under general anesthesia; however, only one of the five included RCTs investigated children undergoing strabismus surgery [37].…”

Appraising and highlighting gaps among prophylactic intervention studies for reducing the incidence of postoperative nausea and vomiting in children: a systematic review

“…The 20 studies were published across a 15-year period (1995–2020) and from 10 different countries: the USA (n=6),12 21 22 25 28 29 Taiwan (n=3),11 13 20 Australia (n=2),14 24 China (n=2),15 27 Germany (n=2),18 19 Belgium (n=1),30 Japan (n=1),16 Brazil (n=1),17 the UK (n=1)23 and India (n=1)26 (tables 1 and 2). Out of 20 eligible studies, only 7 studies included information about funding sources 11 16 18 19 23 24 29.…”

Effects of adding oral clonidine to standard treatments on pain intensity of patients with acute renal colic: A randomized clinical trial

“…Studies have shown that systemic clonidine is effective in reducing acute postoperative pain and that systemic clonidine can also be helpful in reducing chronic pain. [ 13 14 ] For better control of renal colic, a combination of two drugs can be used instead of one. So far, several studies have been performed to evaluate the effect of opioids alone or in combination with another drug, as well as the effect of systemic clonidine in reducing pain.…”