Epidural clonidine decreases postoperative requirements for epidural fentanyl.
OBJECTIVE
This study assesses the possibility that clonidine may decrease analgesic opioid demand in postoperative patients.


METHODS
Twenty-five patients were allocated randomly after abdominal surgery to receive either an epidural bolus dose of fentanyl (1.0 mcg.kg-1) followed by a 1.0 mcg.kg-1h-1 continuous epidural infusion, or an epidural bolus dose of fentanyl (1.0 mcg.kg-1) followed by a continuous epidural infusion combining fentanyl 0.5 mcg.kg-1 x h-1 and clonidine 0.3 mcg.kg-1 x h-1. Pain was assessed at definite intervals on a visual analog scale (VAS) over 3 postoperative days. Epidural infusion was halved when VAS score was lower than 2. Patients were monitored with a pulse oximeter over 12 hours during the first postoperative night. Plasma fentanyl was measured by radioimmunoassay when patients left the recovery room and at 8 a.m. on the first and the second postoperative days.


RESULTS
VAS scores were comparable in the two groups of patients. The amount of fentanyl delivered was significantly lower in the fentanyl + clonidine group, as were the plasma fentanyl concentrations. The duration of SaO2 < 90% episodes was significantly less prolonged in the fentanyl + clonidine group (3.5 +/- 4.8 minutes versus 14.4 +/- 14.6 minutes).


CONCLUSIONS
The combination of clonidine to epidural fentanyl allows a decrease in opioid requirements without impairing analgesia. Reduction of opioids administration may have beneficial effects on respiratory function in postoperative patients.
Delaunay
L
L
Service d'Anesthésie Réanimation, Hôpital Henri Mondor, Créteil, France.
Leppert
C
C
Dechaubry
V
V
Levron
J C
JC
Liu
N
N
Bonnet
F
F
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D003000:Clonidine; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*
D003000:Clonidine; D005283:Fentanyl