Should We Add Clonidine to Local Anesthetic for Peripheral Nerve Blockade? A Qualitative Systematic Review of the Literature

Abstract

Clonidine improves duration of analgesia and anesthesia when used as an adjunct to intermediate-acting local anesthetics for some peripheral nerve blocks. Side-effects appear to be limited at doses up to 150 mug. Evidence is lacking for the use of clonidine as an adjunct to local anesthetics for continuous catheter techniques. Further research is required to examine the peripheral analgesic mechanism of clonidine.

Comparative Study Between Dexmedetomidine and Clonidine as an Adjunct to Bupivacaine in Brachial Plexus Block in Orthopaedic Surgeries

“…In our study, duration of motor block was more prolonged when dexmedetomidine was added to bupivacaine as compared to clonidine was added to bupivacaine. We also observed the mean duration of sensory block was significantly higher (P < 0.001) in group D. McCartney et al 12 found that a bupivacaine and clonidine combination prolonged postoperative analgesia compared to bupivacaine alone when administered for various peripheral nerve blocks. Eledjam J.J et al 13 , showed clonidine is an attractive alternative to epinephrine to prolong duration of analgesia in supraclavicular brachial plexus block.…”

Addition of clonidine or lignocaine to ropivacaine for supraclavicular brachial plexus block: a comparative study

“…Our findings are in agreement with previous systematic reviews, which demonstrated that clonidine, when used as an adjuvant to local anaesthetics, improves anaesthesia and the analgesic duration of the local anaesthetic block. (1,2) The early onset of sensory and motor blocks in the R L group of the present study is likely related to the pharmacological properties of lignocaine. In the R C group, the combined vasoconstrictive property of clonidine (13) and ropivacaine (14) may have led to the greater availability of these drugs at the vicinity of the nerve plexus; this may possibly account for the earlier onset of sensory and motor blocks seen in the R C group, as compared to the R O group.…”

“…Clonidine, when used as an adjuvant to intermediate or long-acting local anaesthetics, improves the duration of analgesia and anaesthesia in brachial plexus or peripheral nerve blocks. (1,2) Although ropivacaine is a chemical congener of bupivacaine, the effect of clonidine when added to ropivacaine for brachial plexus block remains controversial, with some studies not supporting the analgesia-enhancing effects of clonidine as an adjuvant to ropivacaine. (3)(4)(5) However, in these studies, the blocks were performed using an axillary approach.…”

Does the addition of dexamethason to local anesthetic prolong the analgesia of interscalen plexus brachialis block in patients with shoulder surgery?

“…Pneumothorax, hemothorax, Horner's syndrome and phrenic nerve block are the potential complications (1). Generally, a major limitation of peripheral nerve blocks can be a limited duration of analgesia (2). In order to circumvent that limitation, peripheral nerve catheters that offer continuously delivery of local anesthetics have been proposed as an efficient method of postoperative analgesia (3).…”