Epinephrine and clonidine do not improve intrathecal sufentanil analgesia after total hip replacement.
BACKGROUND
We compared analgesia after intrathecal sufentanil alone, sufentanil with epinephrine 200 microg and sufentanil with clonidine 30 microg in patients after total hip replacement, the endpoints being onset and duration of action.


METHODS
We performed a randomized double-blind study of 45 patients for elective total hip arthroplasty using continuous spinal anaesthesia. As soon as a pain score higher than 3 on a 10 cm visual analogue scale was reported, sufentanil 7.5 microg alone, sufentanil 7.5 microg + epinephrine 200 microg or sufentanil 7.5 microg + clonidine 30 micro g in 2 ml normal saline was given intrathecally. Pain scores, rescue analgesia (diclofenac and morphine) and adverse effects (respiratory depression, postoperative nausea and vomiting, itching) were observed for 24 h after surgery.


RESULTS
Time to a pain score of <3 [6 (SD 1) vs 6 (1) vs 5 (1) min], time to the lowest pain score [7 (2) vs 8 (2) vs 8 (2) min] and time to the first dose of systemic analgesic for a pain score >3 [281 (36) vs 288 (23) vs 305 (30) min] were similar in all three groups. Adverse effects and analgesic requirements during the first 24 h were also similar.


CONCLUSIONS
After total hip replacement, all three analgesic regimens gave good analgesia with comparable onset and duration of action, and minor adverse effects.
Fournier
R
R
Department of Anaesthesiology, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland.
Van Gessel
E
E
Weber
A
A
Gamulin
Z
Z
D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics; D000701:Analgesics, Opioid; D019644:Arthroplasty, Replacement, Hip; D001794:Blood Pressure / Q000187:drug effects; D003000:Clonidine; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004837:Epinephrine; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017409:Sufentanil
D000700:Analgesics; D000701:Analgesics, Opioid; D017409:Sufentanil; D003000:Clonidine; D004837:Epinephrine