Epidural clonidine for treatment of postoperative pain after thoracotomy. A double-blind placebo-controlled study

: Clonidine has been reported to produce analgesia in humans in different painful conditions. The aim of the present study was to investigate if epidural clonidine produced a clinically important analgesia to severe postoperative pain. Using a controlled, randomized double-blind design, one group of patients received a single dose of epidural clonidine 3 micrograms/kg (n = 10) and a control group epidural 0.9% saline (n = 10), when reporting postoperative pain after thoracotomy performed under standardized anaesthesia. To quantify the effects of the given epidural drugs, the need for supplementary, intravenous pethidine analgesia was recorded. The patients had access to the supplementary analgesic by means of a patient-controlled analgesic-delivery device. The two groups were similar regarding anthropometric and clinical data. Epidural clonidine 3 micrograms/kg did not affect the need for supplementary intravenous pethidine analgesia, as compared to the control group at any time during the first 12 h postoperatively. The side-effects of epidural clonidine were tolerable, and no treatment for arterial hypotension was required. No early or delayed respiratory depression occurred. In conclusion, clonidine 3 micrograms/kg epidurally seems to lack clinically important analgesic effects on severe postoperative pain, at least following thoracotomy.

[1]  Y. Olsson,et al.  Evaluation of the Toxicity of Subarachnoid Clonidine, Guanfacine, and a Substance P‐Antagonist on Rat Spinal Cord and Nerve Roots: Light and Electron Microscopic Observations after Chronic Intrathecal Administration , 1986, Anesthesia and analgesia.

[2]  T. Gordh,et al.  Effect of Epidural Clonidine on Spinal Cord Blood Flow and Regional and Central Hemodynamics in Pigs , 1986, Anesthesia and analgesia.

[3]  R. Moore,et al.  ROLE OF SPINAL NORADRENERGIC SYSTEM IN TRANSMISSION OF PAIN IN PATIENTS WITH SPINAL CORD INJURY , 1986, The Lancet.

[4]  R. Batra,et al.  Clinical study on epidural clonidine for postoperative analgesia. , 1986, The Indian journal of medical research.

[5]  P. Hartvig,et al.  Cerebrospinal fluid and plasma concentrations of clonidine in pigs after epidural, intravenous and intramuscular administration. , 1986, Upsala journal of medical sciences.

[6]  L. Wiklund,et al.  A method for reliable and simultaneous cannulation of the epidural and subarachnoid spaces in pigs. A tool for the study of cerebrospinal fluid pharmacokinetics and drug penetration of the dura mater. , 1986, Upsala journal of medical sciences.

[7]  S. Savage,et al.  Intrathecal morphine tolerance: use of intrathecal clonidine, DADLE, and intraventricular morphine. , 1985, Anesthesiology.

[8]  S. Arnér,et al.  Differential Effects of Epidural Morphine in the Treatment of Cancer‐related Pain , 1985, Acta anaesthesiologica Scandinavica.

[9]  T. Yaksh,et al.  The physiology and pharmacology of spinal opiates. , 1985, Annual review of pharmacology and toxicology.

[10]  J. Palacios,et al.  Distribution of α2-adrenergic receptors in the human brainstem: An autoradiographic study using [3H]p-aminoclonidine , 1984 .

[11]  T. Gordh,et al.  EPIDURAL CLONIDINE PRODUCES ANALGESIA , 1984, The Lancet.

[12]  T. Gordh,et al.  Evaluation of possible spinal neurotoxicity of clonidine. , 1984, Upsala journal of medical sciences.

[13]  J. Kehne,et al.  Spinal clonidine inhibits neural firing in locus coeruleus , 1983, Brain Research.

[14]  T. Yaksh,et al.  Effects on nociceptive threshold and blood pressure of intrathecally administered morphine and α-adrenergic agonists , 1983, Neuropharmacology.

[15]  J. Y. Wang,et al.  Selective antagonism of the antinociceptive effect of intrathecally applied alpha adrenergic agonists by intrathecal prazosin and intrathecal yohimbine. , 1983, The Journal of pharmacology and experimental therapeutics.

[16]  L. Gustafsson,et al.  ADVERSE EFFECTS OF EXTRADURAL AND INTRATHECAL OPIATES: REPORT OF A NATIONWIDE SURVEY IN SWEDEN , 1982 .

[17]  T. Yaksh,et al.  Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, alpha-adrenergic agonists and baclofen. , 1981, Anesthesiology.

[18]  P. Edlund.  Determination of clonidine in human plasma by glass capillary gas chromatography with electron-capture detection. , 1980, Journal of chromatography.

[19]  F. Magora,et al.  EPIDURAL MORPHINE IN TREATMENT OF PAIN , 1979, The Lancet.

[20]  John E. Thomas,et al.  Pain relief by intrathecally applied morphine in man. , 1979, Anesthesiology.

[21]  L. Paalzow.  Analgesia produced by clonidine in mice and rats , 1974, The Journal of pharmacy and pharmacology.

[22]  B. Simpson,et al.  The incidence of postoperative pain. , 1961, British journal of anaesthesia.