title: Randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine.
abstract: OBJECTIVE
  To investigate the efficacy of the combination of intrathecal morphine with clonidine in comparison with 2 doses of intrathecal morphine alone for postcesarean analgesia.
  
  
  METHODS
  Prospective, double-blinded, randomized clinical trial.
  
  
  METHODS
  Maternity ward of Hospital Santa Cruz, Curitiba, Paraná, Brazil (operating room and ward).
  
  
  METHODS
  The study included 195 American Society of Anesthesiologist I to III singleton parturients undergoing elective cesarean section.
  
  
  METHODS
  The patients were randomized into 3 groups (M50, M100, and M/C). Patients were anesthetized intrathecally with 12 mg of 0.5% hyperbaric bupivacaine and 50 μg or 100 μg morphine (groups M50 and M100, respectively) or 50 μg morphine and 75 μg clonidine (group M/C).
  
  
  METHODS
  The patients were subsequently assessed for pain levels and side effects at 9 to 11 hours and 22 to 24 hours after the injection.
  
  
  RESULTS
  There was no difference in the quality of pain relief among the groups. In all 3 groups, pain was more intense during the first assessment. Pruritus and nausea were more frequent in group M100, and dizziness was more frequent in group M/C; however, these results were statistically insignificant. The group receiving clonidine showed a significantly lower incidence of shivering compared with the other groups.
  
  
  CONCLUSIONS
  At these doses, there was no benefit of associating clonidine with morphine to improve postcesarean analgesia. Considering that higher doses of morphine were associated with more side effects, 50 μg of intrathecal morphine alone seems to be a better option for analgesia. The use of clonidine to reduce postoperative shivering must be balanced against the potential risks of hypotension, bradycardia, dizziness, and sedation.
authors.affiliation: Department of Anesthesiology and Pain Treatment, Hospital Santa Cruz, 1889, Batel Av, Batel, Curitiba, Paraná, Brazil 80420-090. Electronic address: chicoegydio@yahoo.com.br.
authors.forename: Francisco A E
authors.initials: FA
authors.lastname: Carvalho
authors.affiliation: Surgery Department and Anesthesiology Service, Hospital de Clínicas, Universidade Federal do Paraná, General Carneiro St, Downtown, Curitiba, Paraná, Brazil 80.060-900. Electronic address: sbtenorio@gmail.com.
authors.forename: Sérgio B
authors.initials: SB
authors.lastname: Tenório
authors.affiliation: Department of Anesthesiology and Pain Treatment, Hospital Santa Cruz, 1889, Batel Av, Batel, Curitiba, Paraná, Brazil 80420-090. Electronic address: ftshiohara@yahoo.com.br.
authors.forename: Fabiano T
authors.initials: FT
authors.lastname: Shiohara
authors.affiliation: Department of Anesthesiology and Pain Treatment, Hospital Santa Cruz, 1889, Batel Av, Batel, Curitiba, Paraná, Brazil 80420-090. Electronic address: luizrm83@yahoo.com.br.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Maia
authors.affiliation: Department of Anesthesiology and Pain Treatment, Hospital Santa Cruz, 1889, Batel Av, Batel, Curitiba, Paraná, Brazil 80420-090. Electronic address: angelamota01@hotmail.com.
authors.forename: Angela
authors.initials: A
authors.lastname: Mota
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002585:Cesarean Section / Q000379:methods*; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000139:chemically induced; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D011537:Pruritus / Q000453:epidemiology
chemical_list: D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D009020:Morphine; D003000:Clonidine
keywords: Cesarean; Clonidine; Intrathecal; Morphine; Postoperative analgesia