title: [Clonidine for remifentanil-induced hyperalgesia: a double-blind randomized, placebo-controlled study of clonidine under intra-operative use of remifentanil in elective surgery of the shoulder].
abstract: BACKGROUND
  In the postoperative period, α2-adrenergic agonists have an opioid sparing effect. In a previous, experimental study, it was also shown that clonidine attenuates remifentanil-induced hyperalgesia. In this study, we examined under clinical conditions whether early administration of a single dose of clonidine can inhibit remifentanil-induced hyperalgesia in patients undergoing elective surgery of the shoulder and with continuous intraoperative use of remifentanil.
  
  
  METHODS
  In this study 40 patients received double-blind and randomized either 150 µg clonidine or placebo intravenously before skin incision. Anaesthesia was maintained with propofol and remifentanil (0.23 ± 0.09 µg/kg body weight/min) and morphine (0.1 mg/kg body weight) was administered 20 min before incision closure. Postoperatively, the patients were given a patient-controlled analgesia pump (PCA) with morphine.
  
  
  RESULTS
  Overall morphine consumption as well as overall assessment of pain with the visual analogue scale in the first 24 h postoperatively did not differ significantly between the groups. Isolated pain scores at 12 h and 24 h were significantly enhanced in the clonidine group (p<0.05).
  
  
  CONCLUSIONS
  An early single dose of 150 µg of clonidine did not reduce the postoperative morphine consumption and pain scores in patients undergoing elective surgery of the shoulder with remifentanil/propofol-based anaesthesia. After the effect of clonidine has presumably subsided the pain can even increase, therefore further studies with repetitive doses of clonidine should be carried out.
authors: Institut für Anästhesie und Intensivmedizin, AUVA Unfallkrankenhaus Klagenfurt, Waidmannsdorferstr 35, 9021 Klagenfurt, Österreich. c.schlimp@gmx.at
authors: C J
authors: CJ
authors: Schlimp
authors: W
authors: W
authors: Pipam
authors: C
authors: C
authors: Wolrab
authors: C
authors: C
authors: Ohner
authors: H I
authors: HI
authors: Kager
authors: R
authors: R
authors: Likar
references: Anesth Analg. 2007 Jun;104(6):1397-403, table of contents
references: 17513631
references: Anesthesiology. 2000 Aug;93(2):409-17
references: 10910490
references: Schmerz. 2005 Oct;19(5):386-90, 392-4
references: 16096767
references: Schmerz. 2006 Aug;20(4):293-4, 296-9
references: 16205905
references: Acta Anaesthesiol Scand. 2005 Nov;49(10):1464-70
references: 16223391
references: Anesthesiology. 1991 Oct;75(4):577-82
references: 1928767
references: Anesthesiology. 2003 Jul;99(1):152-9
references: 12826855
references: Anaesthesist. 2007 Oct;56(10):1038-46
references: 17762929
references: Can J Anaesth. 2008 Dec;55(12):813-8
references: 19050084
references: Anesthesiology. 2005 Jul;103(1):147-55
references: 15983467
references: Anesthesiology. 2000 Nov;93(5):1345-9
references: 11046225
references: Anesth Analg. 2004 Jan;98(1):153-158
references: 14693611
references: Curr Opin Anaesthesiol. 2001 Oct;14(5):513-8
references: 17019139
references: Can J Anaesth. 1992 Jul;39(6):537-44
references: 1643675
references: Addiction. 2002 Jan;97(1):49-58
references: 11895270
references: Anesthesiology. 2006 Nov;105(5):1016-23
references: 17065897
references: Anaesthesist. 2004 May;53(5):455-66
references: 15034638
references: Anesthesiology. 2004 Jun;100(6):1538-44
references: 15166576
references: Anasthesiol Intensivmed Notfallmed Schmerzther. 2003 Dec;38(12):772-80
references: 14666440