Effects of clonidine preemptive analgesia on acute postoperative pain in abdominal surgery

Peršec, Jasminka and Peršec, Zoran and Buković, Damir and Husedžinović, Ino and Buković, Nevia and Pavelić, Ljubomir (2007) Effects of clonidine preemptive analgesia on acute postoperative pain in abdominal surgery. Collegium Antropologicum, 31 (4). pp. 1071-1075. ISSN 0350-6134

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Abstract

Preemptive analgesia refers to blockade of afferent nerve fibers before a painful stimulus, which prevents or reduces subsequent pain even beyond the effect of the block. The aim of the study was to compare the effect of clonidine used before and at the end of operation on pain control in abdominal surgery. A total of 77 patients admitted for colorectal surgery were randomly classified into three groups: epidural clonidine before operation, epidural clonidine at the end of operation, and control group. After the operation on patient demand, analgesia with boluses of epidural morphine was instituted. The parameters of postoperative pain level using VAS score (visual analog scale), sedation and analgesics consumption were determined as outcome measures at 1, 2, 6, and 24 h of the operation. Clonidine administered before operation provided lowest pain scores at 6 and 24 h (p < 0.05). Clonidine administered at the end of operation had low pain scores at 1 and 2 h, with a significant pain breakthrough thereafter (6.93 +/- 1.66 at 6 h and 4.04 +/- 2.39 at 24 h) compared with the group administered clonidine before operation (3.60 +/- 2.94 and 3.71 +/- 1.82). Clonidine administered before operation provided less sedation (p < 0.05) and a significantly lower use of analgesics (p < 0.05). Blockade of nociceptive stimulus using the centrally acting alpha2-adrenergic agonist clonidine before the onset of pain stimulus resulted in reduced pain levels, sedation and analgesic requirement.

Abstract in Croatian

Preemptivna analgezija podrazumijeva blokadu uzlaznih živčanih puteva prije nastanka bolnog podražaja, čime se sprječava ili smanjuje razina nastale boli. Cilj ove studije bila je usporedba učinka klonidina primjenjenog prije operacije i na kraju operacije na smanjenje poslijeoperacijske boli. Ukupno 77 bolesnika predviđenih za operacijski zahvat u kolorektalnoj kirurgiji metodom randomizacije podijeljeno je u tri skupine: epiduralni klonidin prije operacije, epiduralni klonidin na kraju operacije i kontrolna skupina. Nakon operacijskog zahvata, na zahtjev bolesnika primjenjivana je epiduralna analgezija bolusima morfina. Kao mjere ishoda istraživanja, u vremenskom slijedu 1., 2., 6., i 24. sata od operacijskog zahvata proučavani su parametri razine poslijeperacijske boli korištenjem VAS ljestvice (vizualno analogna skala), sedacije i potrošnje analgetika. Klonidin primjenjen prije operacije iskazao je značajno niže vrijednosti boli u 6. i 24. satu ispitivanja (p<0,05). Klonidin primjenjen na kraju operacije imao je niže vrijednosti boli u 1. i 2. satu, s značajnim porastom razine boli nakon tog vremena (6,93±1,66 u 6. satu i 4,04±2,39 u 24. satu) u usporedbi s klonidinom prije operacije (3,60±2,94 i 3,71±1,82). Klonidin prije operacije iskazao je značajno nižu razinu sedacije (p<0,05) i manju potrošnju analgetika (p<0,05). Blokada nocicepcijskog impulsa primjenom centralno djelujućeg a2-adrenergičkog agonista klonidina prije nastanka osjeta boli dovodi do smanjenja razine poslijeoperacijske boli, sedacije i potrebe za analgeticima.

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