title: [Analgesia and hemodynamics under 8 mu/kg clonidine for pain therapy following major abdominal surgery].
abstract: OBJECTIVE
  To characterise the haemodynamic profile after epidural injection of high-dose clonidine for postoperative pain management and to establish recommendations for the therapy of haemodynamic instabilities.
  
  
  METHODS
  20 patients with major surgery on pancreas, stomach or infrarenal aorta took part in the study. Anaesthesia was a combined epidural/inhalational regimen with bupivacaine 0.25%, enflurane, oxygen/nitrous oxide, fentanyl 0.1 mg and pancuronium. Postoperative analgesia consisted of morphine 50 micrograms/kg in 10 ml NaCl 0.9% for the first 12 postoperative hours; if pain > = 5 points on the VAS occurred after > 12 h postoperatively clonidine 8 micrograms/kg in 10 ml NaCl 0.9% was injected epidurally and the pain intensity (self-assessment by the patient using the visual analog scale) and circulation (invasive pressure monitoring, pulmonary artery catheter) was monitored for 60 minutes in ten minutes intervals.
  
  
  RESULTS
  The reduction of the initial VAS score of 6 was 50% after 20 minutes and 100% after 60 minutes. We observed a significant decline in heart rate (87 +/- 11 (t0), 74 +/- 10 min-1 (t60)), mean arterial pressure (97 +/- 17 (t0), 72 +/- 15 mmHg (t60)) and cardiac output (8.7 +/- 1.3 (t0), 7.0 +/- 1.3 l.min-1 (t60)) (all p < 0.001) and no change of systemic vascular resistance. Filling pressures (CVP and PCWP) remained stable. In 9 patients the mean arterial pressure fell below 60 mmHg (always within the first 40 min); 6 of these patients responded to infusion of a colloid (500 ml of hydroxyethyl starch at > = 2 ml/kg.min) whereas the other 3 patients needed a bolus injection of a betamimetic catecholamine (theodrenaline/cafedrine, Akrinor).
  
  
  CONCLUSIONS
  Epidural clonidine 8 micrograms/kg causes rapid and intense analgesia. Haemodynamic instability is a consequence of a drop in heart rate and has to be treated accordingly. The application of a pure vasopressor does not seem to be indicated taking in account the fact that the total peripheral resistance remains unchanged and in the normal range.
authors.affiliation: Universitätsklinik für Anästhesiologie, Klinikum der Universität Ulm.
authors.forename: M G
authors.initials: MG
authors.lastname: Rockemann
authors.forename: A
authors.initials: A
authors.lastname: Brinkmann
authors.forename: A
authors.initials: A
authors.lastname: Goertz
authors.forename: W
authors.initials: W
authors.lastname: Seeling
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D003000:Clonidine / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007268:Injections, Epidural; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D003000:Clonidine
vernacular_title: Analgesie und Hämodynamik unter 8 mu/kg Clonidin epidural zur Schmerztherapie nach grossen abdominellen Eingriffen.