The Dose-Response Relationship for Clonidine Added to a Postoperative Continuous Epidural Infusion of Ropivacaine in Children

Negri, Pasquale De; Ivani, Giorgio; Visconti, Ciro; Vivo, P. De; Lönnqvist, Per Arne

doi:10.1097/00000539-200107000-00016

Cited by 78 publications

(36 citation statements)

References 26 publications

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“…Post-operative complication i.e. nausea, vomiting are less in epidural clonidine group than epidural fentanyl which coincides with the study of Topcu I et al [21] Pruritis is more with epidural fentanyl group than epidural clonidine group which coincides with the findings of Sinatra RS et el, Halonen DM et al [22] In the present study epidural bupivacaineclonidine group found to be devoid of any marked side effects compared to bupivacaine-fentanyl group which coincides with the studies of Constant I et al, Negri PD et al, Cucchiaro et al [20,23,24] …”

Section: Section: Anaesthesiasupporting

confidence: 91%

Epidural Fentanyl Vs Epidural Clonidine for Postoperative Analgesia: A Comparative Study

Mishra¹,

Mishra²,

Satapathy³

2017

Ann. Int. Med. Den.Res.

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Section: Section: Anaesthesiasupporting

confidence: 91%

Epidural Fentanyl Vs Epidural Clonidine for Postoperative Analgesia: A Comparative Study

Mishra¹,

Mishra²,

Satapathy³

2017

Ann. Int. Med. Den.Res.

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“…18 Epidural adjuvants, such as clonidine (0.08-0.12 lgÁkg -1Áhr -1 ) added to a continuous epidural infusion of 0.08% ropivacaine (0.16 mgÁkg -1 Áhr -1 ), reduce the required dose of anesthetic and enhance analgesia. 19 A local anesthetic-opioid combination is also effective. For example, a double-blind randomized comparison of three solutions administered by continuous epidural infusion (15 mLÁhr -1 ) for postoperative analgesia (0.125% bupivacaine in 0.9% saline, diamorphine in 0.9% saline [0.5 mg in 15 mL], ordiamorphine mixed with 0.125% bupivacaine) was shown to be superior to each modality alone, yielding better pain relief with fewer adverse effects following major gynecological surgery.…”

Section: Developmentsmentioning

confidence: 99%

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Tan

Law

Gan

2014

Can J Anesth/J Can Anesth

277

206

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“…We used a relatively high dose of clonidine (up to 0.75lg/ kg/h) compared with previously published studies that added epidural clonidine to local anaesthetic agents. 7,9,13 This was based on our institutional practice that took into account the specific problems of postoperative pain and muscle spasm in children with CP undergoing SEMLS and evidence that higher doses of clonidine could be beneficial. Analgesia is enhanced with increasing dose.…”

Section: Discussionmentioning

confidence: 99%

“…6 The use of epidural clonidine has several potential benefits. It enhances and prolongs the sensory nerve block of local anaesthetics 7 and produces fewer side effects than epidural morphine 8 or fentanyl. 9,10 In addition, clonidine has anti-spasm properties 11 and little respiratory depressant effect.…”

mentioning

confidence: 99%

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Chalkiadis

Sommerfield

Low

et al. 2015

Develop Med Child Neuro

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AUCArea under the curve SEMLS Single-event multilevel surgery AIM To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery.METHOD Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]).RESULTS There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001).INTERPRETATION Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile.Cerebral palsy (CP) by definition is a disorder of movement and posture, caused by a non-progressive brain injury or lesion. 1 However, although the causative brain lesion is defined as a static encephalopathy, the musculoskeletal pathology in the limbs is progressive during the child's growth and maturation, with the development of contractures, bony torsion, and joint instability. Children with CP may undergo extensive orthopaedic surgery of the lower extremities to correct deformity and improve function. Single-event multilevel surgery (SEMLS), defined as at least one surgical procedure, performed on two different anatomical levels (hip, knee, or ankles), has been shown to result in dramatic improvements in gait and functioning, which are sustained at 5-year follow-up and reduce the need for serial surgeries and periods of rehabilitation. 2,3 Good pain control is important for patient comfort and facilitates early rehabilitation and discharge. Effective pain management is challenging because of multiple surgical incisions, associated comorbidities (chronic lung disease, risk of aspiration, epilepsy, gastro-oesophageal reflux), and impairments in communication and/or cognition that may make pain assessment difficult. In addition, the surgical nociceptive input is likely to lead to wind-up of spinal reflexes and worsening of muscle spasm 4 and possibly to an escalating pain-spasm cycle. Epidural analgesia is the preferred modality of regional anaesthesia in our institution but there are limited data...

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The Dose-Response Relationship for Clonidine Added to a Postoperative Continuous Epidural Infusion of Ropivacaine in Children

Abstract: The addition of clonidine (0.08-0.12 microg.kg(-1).h(-1))to a continuous epidural infusion of ropivacaine was found to improve postoperative pain relief in children. No clinically significant signs of sedation or other side effects were observed.

Cited by 78 publications

References 26 publications

Epidural Fentanyl Vs Epidural Clonidine for Postoperative Analgesia: A Comparative Study

Epidural Fentanyl Vs Epidural Clonidine for Postoperative Analgesia: A Comparative Study

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

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