The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery.
The postoperative period is associated with an increased production of cytokines, which augment pain sensitivity. We investigated the hypothesis that epidural clonidine premedication and postoperative patient-controlled epidural analgesia (PCEA) including clonidine would decrease the release of proinflammatory (interleukin (IL)-6, IL-1beta, IL-8, and tumor necrosis factor (TNF)-alpha) and antiinflammatory (IL-1 receptor antagonist (RA)) cytokines in patients who underwent elective colorectal surgery and that they would provide better postoperative analgesia. Forty patients were randomly assigned to 1 of 2 groups of 20 each: the control group received normal saline 10 mL, whereas the clonidine group received epidural clonidine 150 microg diluted with 9 mL of normal saline 30 min before surgery. Venous blood samples for cytokine levels were obtained before induction, at the end of surgery, and after surgery at 12 and 24 h. After surgery, the clonidine group patients received PCEA with morphine (0.1 mg/mL) and clonidine (1.5 microg/mL) in 0.2% ropivacaine 100 mL, whereas control group patients received only PCEA morphine and ropivacaine. Patients in the clonidine group exhibited longer PCEA trigger times, lower pain scores at rest and while coughing, less morphine consumption, and a faster return of bowel function throughout the 72-h postoperative observation period, compared with patients in the control group. For patients in the clonidine group, production of IL-1RA, IL-6, and IL-8 was significantly less increased at the end of the surgical procedure and at 12 and 24 h after surgery. However, the concentrations of IL-1beta and TNF-alpha were not significantly increased.
Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, National Defense University, #325, Section 2, Chenggung Rd., Neihu 114, Taipei, Taiwan, Republic of China. wuchingtang@msn.com
Ching-Tang
CT
Wu
Shu-Wen
SW
Jao
Cecil O
CO
Borel
Chun-Chang
CC
Yeh
Chi-Yuan
CY
Li
Chueng-He
CH
Lu
Chih-Shung
CS
Wong
D000316:Adrenergic alpha-Agonists / Q000493:pharmacokinetics; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects; D003000:Clonidine / Q000493:pharmacokinetics; D003106:Colon / Q000187:drug effects* / Q000601:surgery; D016207:Cytokines / Q000097:blood*; D013505:Digestive System Surgical Procedures; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012007:Rectum / Q000601:surgery
D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D016207:Cytokines; D009020:Morphine; D003000:Clonidine