title: Analgesic and hemodynamic effects of epidural clonidine, clonidine/morphine, and morphine after pancreatic surgery--a double-blind study.
abstract: This study characterizes analgesia an hemodynamics after epidural clonidine 8 micrograms/kg (Group C) or clonidine 4 micrograms/kg+morphine 2 mg (Group CM) in comparison to epidural morphine 50 micrograms/kg (Group M). Forty-five patients scheduled for pancreatectomy in combined general/epidural anesthesia were studied. The study drugs were administered 75 min postoperatively and for 10 h pain intensity (visual analog scale [VAS]), heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO) were measured; filling pressures were kept > 5 mm Hg. Adequate analgesia could be achieved within 1 h in all patients of Groups C and CM, but only in six patients of Group M (P < 0.001). Quality of analgesia was comparable in all groups (VAS reduction 82% +/- 20%, mean +/- SD) but duration of analgesic action was longer in Groups CM (586 +/- 217 min) and M (775 +/- 378 min) compared to Group C (336 +/- 119 min) (P < 0.001). In Group M, no hemodynamic alterations occurred. In Groups C and CM, HR, CO, and MAP were reduced significantly compared to baseline within the first 15-90 min, while stroke volume and systemic vascular resistance remained stable. We conclude, that hemodynamic alteration after epidural clonidine under conditions of stable filling pressures is caused mainly by a decrease in HR. It is not an effect of analgesia but of the intrinsic antihypertensive action of clonidine.
authors.affiliation: Universitätsklinik für Anästhesiologie, Ulm, Germany.
authors.forename: M G
authors.initials: MG
authors.lastname: Rockemann
authors.forename: W
authors.initials: W
authors.lastname: Seeling
authors.forename: A
authors.initials: A
authors.lastname: Brinkmann
authors.forename: A W
authors.initials: AW
authors.lastname: Goertz
authors.forename: N
authors.initials: N
authors.lastname: Hauber
authors.forename: J
authors.initials: J
authors.lastname: Junge
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
mesh_terms: D015360:Analgesia, Epidural; D003000:Clonidine / Q000008:administration & dosage / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000494:pharmacology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D010180:Pancreatectomy; D011446:Prospective Studies
chemical_list: D009020:Morphine; D003000:Clonidine