[Controlled analgesia in a burn patient: fentanyl sparing effect of clonidine].
OBJECTIVE
To determine the sparing effect of clonidine (C) on fentanyl (F) demand in burned patients under PCA.


METHODS
Prospective, randomized, double blind study versus placebo.


METHODS
Twelve consecutive patients with mean burn surface area of 20 +/- 9%, studied between the third and the eighth day post-burn.


METHODS
F was delivered by a PCA pump (bolus: 1 mg.kg-1). In the morning, burn patients received additional F (5 mg.kg-1) before hydrotherapy. After randomisation, C or placebo (P) were alternatively infused over 24 hours. Demands for F during the morning, the afternoon and the evening were noted. Pain scores were measured on a visual analogic scale. In eight patients, plasma levels of F (pF) were iteratively measured. Heart rate, arterial pressure, respiratory rate and SpO2 were monitored.


RESULTS
Analgesic demands were 19.5/day under P and 9.5 under C (P < 0.0001). Pain reoccurred for pF of 4.1 under C vs 5.7 under P (P < 0.05) with same pain scores in the two groups. After a pain stimulus, pain scores were lower under F, despite lower pF (P < 0.05). Arterial pressure and heart rate were significantly lowered during the first hour of C infusion.


CONCLUSIONS
Doses of F and pF required to reach analgesia were very high. Adding C decreases by 50% the F demand and lowers pF. Minor haemodynamic effects were observed during the first hour of C infusion.
Viggiano
M
M
Département d'anesthésie-réanimation, hôpital de la Conception, Marseille, France.
Badetti
C
C
Roux
F
F
Mendizabal
H
H
Bernini
V
V
Manelli
J C
JC
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D016058:Analgesia, Patient-Controlled; D002056:Burns / Q000150:complications* / Q000628:therapy; D003000:Clonidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004347:Drug Interactions; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D011446:Prospective Studies
D000316:Adrenergic alpha-Agonists; D009294:Narcotics; D003000:Clonidine; D005283:Fentanyl