title: Addition of clonidine to epidural morphine enhances postoperative analgesia after cesarean delivery.
abstract: OBJECTIVE
  The randomized, double-blind, dose-response study was designed to evaluate the effects of the addition of clonidine to epidural morphine on postoperative analgesia and side effects in patients undergoing cesarean delivery.
  
  
  METHODS
  Sixty patients, undergoing cesarean delivery under epidural anesthesia, were randomly divided in three equal groups to receive, at the end of surgery, an epidural analgesic mixture consisting of 10 mL solution containing 2 mg of morphine diluted with 0.125% bupivacaine plus 1:800,000 epinephrine and 0, 75, or 150 micrograms of clonidine. Duration of analgesia was assessed as the pain-free interval between the end of surgery and patient's first analgesic request. The analgesic mixture was repeated, on patient's request, to 36 hours after the operation. Arterial blood pressure, heart rate, respiratory rate, and side effects were noted. The total amount of morphine and clonidine delivered was also noted.
  
  
  RESULTS
  The addition of clonidine (0, 75, or 150 micrograms) to morphine significantly increased the duration of postoperative analgesia (P < .0001) (6.27 versus 13.25 and versus 21.55 hours) and reduced the mean total dose of morphine (9.40 mg versus 5.0 mg versus 3.60 mg) (P < .0001). No significant differences in side effects were noted.
  
  
  CONCLUSIONS
  A low dose of clonidine such as 75 micrograms doubled the duration of analgesia produced by 2 mg of morphine and a dose of 150 micrograms further increased the duration of postoperative complete analgesia without increasing the incidence of side effects. The morphine requirements during the postoperative period (36 hours) was greatly reduced by the addition of clonidine to the analgesic epidural mixture.
authors.affiliation: Department of Anesthesiology, Fatebenefratelli General Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Capogna
authors.forename: D
authors.initials: D
authors.lastname: Celleno
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
authors.forename: P
authors.initials: P
authors.lastname: Costantino
authors.forename: S
authors.initials: S
authors.lastname: Foresta
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D015656:Respiratory Mechanics / Q000187:drug effects
chemical_list: D009020:Morphine; D003000:Clonidine