title: A Double-Blind Randomized Controlled Trial Comparing Epidural Clonidine vs Bupivacaine for Pain Control During and After Lower Abdominal Surgery.
abstract: BACKGROUND
  Alpha-2 adrenergic agonists produce safe and effective analgesia, but most investigations studying the analgesic effect of alpha-2 adrenoceptor agonists postoperatively included previous or concomitant administration of other analgesics. Because clonidine potentiates the effect of these drugs, its own intrinsic analgesic effect has been difficult to establish. This study was designed to compare the intraoperative and postoperative effects of epidural clonidine vs bupivacaine for patients undergoing lower abdominal surgery.
  
  
  METHODS
  This randomized controlled trial included 40 patients aged 18-50 who were scheduled for elective lower abdominal surgery. Patients were randomly divided into 2 groups. Group I (n=20) received epidural clonidine; Group II (n=20) received epidural bupivacaine. Intraoperative and postoperative hemodynamics, pain scores, and complications were monitored.
  
  
  RESULTS
  Mean pain scores were significantly lower in Group I compared to Group II (1.5 ± 0.5 compared to 3.4 ± 1.0, respectively) in the first 12 hours after surgery. Sedation was more prominent in Group I until 9 hours after surgery. Opioid requirements were significantly lower in Group I. Respiratory rate was similar in the 2 groups. Group I had larger decreases from baseline in systolic blood pressure and diastolic blood pressure than Group II. Heart rate in Group I was reduced from baseline, while it was increased in Group II. Less postoperative nausea and vomiting, urinary retention, pruritus, and shivering were observed in Group I.
  
  
  CONCLUSIONS
  Compared to bupivacaine, epidural clonidine provided effective intraoperative and postoperative analgesia in selected patients, resulting in a decreased intravenous pain medication requirement and prolonged duration of analgesia after epidural infusion was discontinued.
authors.affiliation: Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Abd-Elsayed
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Maged
authors.initials: M
authors.lastname: Guirguis
authors.affiliation: College of Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Mark S
authors.initials: MS
authors.lastname: DeWood
authors.affiliation: Department of Anesthesiology, Case Western Reserve University, Cleveland, OH.
authors.forename: Sherif S
authors.initials: SS
authors.lastname: Zaky
keywords: Adrenergic alpha-agonists; analgesia–epidural; bupivacaine; clonidine; intraoperative care; pain–postoperative