Low-dose intrathecal clonidine combined with sufentanil as analgesic drugs in abdominal gynecological surgery.
OBJECTIVE
To determine whether a low dose of spinal clonidine either alone or combined with sufentanil would provide effective analgesia following abdominal surgery, as a supplement to bupivacaine spinal anesthesia.


METHODS
Randomized double-blind study.


METHODS
Gynecological surgery, teaching hospital.


METHODS
73 ASA physical status I and II patients undergoing gynecological abdominal surgery with spinal anesthesia.


METHODS
Patients were randomly assigned to one of four groups and prospectively studied to examine anesthesia, analgesia, and adverse effects. The control group received saline as the test drug; the sufentanil group received 10 microg of sufentanil; the clonidine group received 30 microg of clonidine; and the sufentanil/clonidine group received 5 microg of sufentanil plus 15 microg of clonidine. All groups received intrathecal 15 mg of bupivacaine (3 mL) plus the intrathecal test drug (2 mL). The concept of visual analog scale (VAS) was introduced. All patients were premedicated with intravenous midazolam. Rescue analgesics were available.


RESULTS
The groups were demographically the same. Sensory block to pinprick at 10 min was higher for clonidine and sufentanil/clonidine groups compared to the control group (p < 0.02). Anesthetic time (Bromage score 2) was also longer for clonidine and sufentanil/clonidine groups compared to the control and sufentanil groups (p < 0.05). Time to first rescue analgesics was shorter in the control group compared to the other groups (p < 0.02). The number of IM diclofenac dose injections in 24 hours was higher in the control group compared to all other groups (p < 0.05). The incidence of adverse effects and ephedrine consumption were similar among groups.


CONCLUSIONS
Intrathecal 15- and 30-microg clonidine doses expanded the anesthesia sensory block and duration of motor block, and provided analgesia.
Julião
M C
MC
Discipline of Anesthesiology, Department of Surgery, Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto-USP, São Paulo, Brazil.
Lauretti
G R
GR
D000005:Abdomen; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007278:Injections, Spinal; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011446:Prospective Studies; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use*
D000316:Adrenergic alpha-Agonists; D000700:Analgesics; D000701:Analgesics, Opioid; D017409:Sufentanil; D003000:Clonidine