Intravenous but not perineural clonidine prolongs postoperative analgesia after psoas compartment block with 0.5% levobupivacaine for hip fracture surgery.
We evaluated the systemic and local effects of clonidine as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. In a randomized, prospective, double-blind trial, 36 patients requiring hip fracture surgery received PCB and general anesthesia. Patients were randomized into three groups. Each patient received PCB with 0.4 mL/kg of levobupivacaine 0.5%. The control group (group L) received IV saline, the systemic clonidine group (group IC) received IV clonidine 1 mug/kg, and the peripheral clonidine group (group C) received IV saline and PCB with clonidine 1 microg/kg. The interval from time of completion of block injection to first supplementary analgesic administration was longer in group IC compared with group L (mean +/- sd, 13.4 +/- 6.1 versus 7.3 +/- 3.6 h; P = 0.03). There was no difference between group C and group L (10.3 +/- 5.9 versus 7.3 +/- 3.6 h; P > 0.05). The groups were similar in terms of 24 h cumulative morphine and acetaminophen consumption. There were no significant differences among groups regarding postoperative adverse effects (bradycardia, hypotension, sedation, and nausea). We conclude that IV but not perineural clonidine (1 microg/kg) prolongs analgesia after PCB without increasing the incidence of adverse effects.
Mannion
Stephen
S
Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland.
Hayes
Ivan
I
Loughnane
Frank
F
Murphy
Damian B
DB
Shorten
George D
GD
D000368:Aged; D000369:Aged, 80 and over; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000494:pharmacology*; D003000:Clonidine / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D004311:Double-Blind Method; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007262:Infusions, Intravenous; D000077554:Levobupivacaine; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016658:Psoas Muscles / Q000294:innervation
D000077554:Levobupivacaine; D003000:Clonidine; D002045:Bupivacaine
Stevens RD, Van Gessel E, Flory N, et al. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. Anesthesiology 2000;93:115–21.
Capdevila X, Macaire P, Dadure C, et al. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg 2002;94:1606–13.
Liu SS, Salinas FV. Continuous plexus and peripheral nerve blocks for postoperative analgesia. Anesth Analg 2003;96:263–72.
Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia: a clinical review of clonidine (1984–1995). Anesthesiology 1996;85:655–74.
Singelyn FJ, Dangoisse M, Bartholomee S, Gouverneur JM. Adding clonidine to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Reg Anesth 1992;17:148–50.
Eledjam JJ, Deschodt J, Viel EJ, et al. Brachial plexus block with bupivacaine: effects of added alpha-adrenergic agonists: comparison between clonidine and epinephrine. Can J Anaesth 1991;38:870–5.
MacDonald E, Schein M. Distribution and pharmacology of alpha 2-adrenoceptors in the central nervous system. J Physiol Pharmacol 1995;46:241–58.
Hansen TG, Henneberg SW, Walther-Larsen S, et al. Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double-blind study. Br J Anaesth 2004;92:223–7.
Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 2000;59:551–79.
Gaumann DM, Brunet PC, Jirounek P. Clonidine enhances the effects of lidocaine on C-fiber action potential. Anesth Analg 1992;74:719–25.
Kopacz DJ, Bernards CM. Effect of clonidine on lidocaine clearance in vivo: a microdialysis study in humans. Anesthesiology 2001;95:1371–6.
Bernard JM, Macaire P. Dose-range effects of clonidine added to lidocaine for brachial plexus block. Anesthesiology 1997;87:277–84.
Iskandar H. Guillaume E, Dixmérias F, et al. The enhancement of sensory blockade by clonidine selectively added to mepivacaine after midhumeral block. Anesth Analg 2001;93:771–5.
Erlacher W, Schuschnig C, Koinig H, et al. Clonidine as adjuvant for mepivacaine, ropivacaine and bupivacaine in axillary, perivascular brachial plexus block. Can J Anaesth 2001;48:522–5.
Singelyn FJ, Gouverneur JM, Robert A. A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesth Analg 1996;83:1046–50.
Culebras X, Van Gessel E, Hoffmeyer P, Gamulin Z. Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes. Anesth Analg 2001;92:199–204.
Gerhardt MA, Schlossberg ML, Reilley T. Spinal anesthesia ± intrathecal morphine versus peripheral nerve block ± clonidine for pain control after total knee arthroplasty [abstract]. Anesthesiology 2002;96:A884.
Kawasaki Y, Kumamoto E, Furue H, Yoshimura M. α2 adrenoceptor-mediated presynaptic inhibition of primary afferent glutamatergic transmission in rat substantia gelatinosa neurons. Anesthesiology 2003;98:682–9.
Galitzky J, Lafontan M, Nordenstrom J, Arner P. Role of vascular alpha-2 adrenoceptors in regulating lipid mobilization from human adipose tissue. J Clin Invest 1993;91:1997–2003.
Rosenmeier JB, Dinenno FA, Fritzlar SJ, Joyner MJ. Alpha1- and alpha2- adrenergic vasoconstriction is blunted in contracting human muscle. J Physiol 2003;547:971–6.
Odoom JA, Zuurmond WW, Sih IL, et al. Plasma bupivacaine concentrations following psoas compartment block. Anaesthesia 1986;41:155–8.
Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand 2003;47:1001–5.
Bernard JM, Kick O, Bonnet F. Comparison of intravenous and epidural clonidine for postoperative patient-controlled analgesia. Anesth Analg 1995;81:706–12.
Essen EJ, Bovill JG, Ploeger EJ, Houben JJG. Pharmacokinetics of clonidine after epidural administration in surgical patients: lack of correlation between plasma concentrations and analgesia and blood pressure changes. Acta Anaesthesiol Scand 1992;36:300–4.
de Visme V, Picart F, Le Jouan R, et al. Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly. Reg Anesth Pain Med 2000;25:158–62.