Analysis of preincisional and postincisional treatment with alpha2-adrenoreceptor agonist clonidine regarding analgesic consumption and hemodynamic stability in surgical patients

Peršec, Jasminka and Buković, Damir and Majerić-Kogler, Višnja and Šakić, Katarina and Peršec, Zoran and Kasum, Miro (2007) Analysis of preincisional and postincisional treatment with alpha2-adrenoreceptor agonist clonidine regarding analgesic consumption and hemodynamic stability in surgical patients. Collegium Antropologicum, 31 (4). pp. 1065-1070. ISSN 0350-6134

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Abstract

Preemptive analgesia aims to prevent the sensitization of central nervous system, hence the development of pathologic pain after tissular injury. The aim of the study was to assess the effect of preincisional clonidine treatment on analgesic consumption and hemodynamic stability compared to clonidine administered at the end of the operation and control group. Ninety-one patients undergoing elective colorectal surgery were randomly assigned to four groups: peroral clonidine before operation, epidural clonidine before operation, epidural clonidine at the end of operation, and epidural saline before operation as a control group. After the operation, patient-controlled analgesia with epidural morphine was instituted. Analgesic consumption, blood pressure and heart rate were obtained at 1, 2, 6 and 24 h postoperatively, and the cumulative consumption of analgesics was assessed at the end of the study period. Significant differences (p < 0.05) in postoperative systolic blood pressure, with highest hemodynamic stability was observed at 1 h and 6 h in the group of patients administered epidural clonidine before operation. In this group of patients we found significant reduction in analgesic consumption during the study period (p < 0.05), compared to other groups. The cumulative consumption of analgesics assessed at the end of the study period was significantly reduced (p < 0.05) in the group of patients administered epidural clonidine before operation (8.40 +/- 3.74, respectively) as compared with the peroral clonidine before operation (16.79 +/- 5.75, respectively), epidural clonidine at the end of the operation (11.11 +/- 4.24, respectively) and control group of patients (18.00 +/- 6.45, respectively). Preincisional administration of epidural clonidine was associated with a significantly lower analgesic use, lower cumulative analgesic consumption and greater hemodynamic stability, in comparison with other groups.

Abstract in Croatian

Osnova preemptivne analgezije je sprječavanje nastanka senzitizacije središnjeg živčanog sustava i posljedičnog razvoja patološke boli uslijed tkivne ozljede. Cilj ove studije bila je usporedba učinka prijeoperacijske primjene klonidina na potrošnju analgetika i hemodinamsku stabilnost bolesnika u odnosu na primjenu klonidina na kraju operacije i kontrolnu skupinu. Uzorak od ukupno 91 bolesnika, predviđenih za operacijski zahvat u kolorektalnoj kirurgiji, metodom randomizacije podijeljen je u četiri skupine: klonidin per os prije operacije, epiduralni klonidin prije operacije, epiduralni klonidin na kraju operacije i kontrolna skupina. Nakon operacijskog zahvata, na pojavu osjeta boli svi ispitanici su primili analgetik morfin. Parametri krvnog tlaka, pulsa i učestalosti potrošnje analgetika proučavani su u vremenskom slijedu 1., 2., 6. i 24. sata od operacijskog zahvata, a ukupna potrošnja analgetika na završetku ispitivanja. Značajne razlike (p<0,05) u vrijednostima sistoličkog krvnog tlaka, uz najveću hemodinamsku stabilnost bolesnika dokazane su u skupini s klonidinom primjenjenim epiduralno prije operacije u 1. i 6. satu ispitivanja. U toj skupini bolesnika nađeno je značajno smanjenje primjene analgetika tijekom ispitivanja (p<0,05), u usporedbi s ostalim skupinama. Ukupna potrošnja analgetika na završetku ispitivanja bila je značajno manja (p<0,05) u skupini bolesnika s klonidinom primjenjenim epiduralno prije operacije (8,40±3,74), u usporedbi s klonidinom primjenjenim per os prije operacije (16,79±5,75), klonidinom epiduralno na kraju operacije (11,11±4,24) i kontrolnom skupinom bolesnika (18,00±6,45). Zaključujemo da je prijeoperacijska epiduralna primjena klonidina povezana s smanjenom učestalosti primjene analgetika, smanjenom ukupnom potrošnjom analgetika i većom hemodinamskom stabilnosti, u usporedbi s ostalim ispitivanim skupinama.

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