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Enhancement of intrathecal lidocaine by addition of local and systemic clonidine
Departments of Anaesthesiology and Intensive Care, Kohtla-Järve Hospital, Kohtla-Järve.
University of Tartu, Tartu, Estonia.
1999 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 43, no 5, 556-562 p.Article in journal (Refereed) Published
Abstract [en]

Background: Enhancement of local anaesthetic-produced regional blocks by clonidine seems well established. There are insufficient data about dose-effect relationship of combinations of clonidine with individual agents, efficiency of local versus systemic administration of clonidine, and comparative evaluation of clonidine with vasoconstrictors. Because of unavailability of long-acting local anaesthetics at the time of study, our aim was to evaluate augmentation of lidocaine spinal block with local or systemic clonidine and to compare the results with the efficacy of intrathecal phenylephrine.

Methods: Ninety pts of age 50–72 yrs with ASA 1–4 physical status, scheduled for open prostatectomies, hysterectomies or ostheosynthesis of fractured hip were randomized to one of 6 treatment groups, 15 pts in each. Patients received intrathecally (L3–L4) either 100 mg of plain lidocaine (group L100); or a mixture of lidocaine 40 and 80 mg with clonidine 100 μg (groups L40-C100 and L80-C100); or a combination of lidocaine 40 and 80 mg with clonidine 300 μg orally 60 min before spinal puncture (L40-C300 and L80-C300). Addition of intrathecal phenylephrine 5 mg to 80 mg of lidocaine was also investigated (L80-P5).

Results: There were no significant intergroup differences concerning demographic data or type of surgery. All operations (duration up to 150 min) were completed without need for analgesic supplementation. The addition of clonidine resulted in a significant reduction of the onset time of spinal block and prolongation of the duration of sensory and motor blocks compared to plain lidocaine or lidocaine with phenylephrine. In spite of the well-known hypotensive action of α2-agonists, haemodynamic depression only in group L80-C300 was significantly more pronounced than in L100 and L80-P5 groups. The least decrease of BP and minimal need of rescue ephedrine among all patients studied were recorded in the group receiving low dosage of lidocaine with intrathecal clonidine (L40-C100). Sedation occurred in most patients receiving clonidine.

Conclusion: Our results indicate that addition of clonidine to lidocaine, irrespective of the route of administration, prolongs the duration of spinal block and permits a reduction of the lidocaine dose needed for a given duration of block. Addition of phenylephrine results in a less pronounced statistically significant prolongation of anaesthesia. The regression of sensory block before restoration of motor function seems to be a specific (and unfortunate) effect of both clonidine and phenylephrine.

Place, publisher, year, edition, pages
1999. Vol. 43, no 5, 556-562 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-85055DOI: 10.1034/j.1399-6576.1999.430512.xOAI: diva2:563964
Available from: 2012-11-01 Created: 2012-11-01 Last updated: 2012-11-01
In thesis
1. Perioperative effects of systemic or spinal clonidine as adjuvant during spinal anaesthesia
Open this publication in new window or tab >>Perioperative effects of systemic or spinal clonidine as adjuvant during spinal anaesthesia
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim of study: To evaluate the effects of different doses of clonidine administered systemically or spinally in combination with local anaesthetics on sensory and motor block intraoperatively, on pain relief postoperatively, and on the incidence of postoperative alcohol withdrawal syndrome (AWS) in alcohol abusers.

Patients and methods: A total 285 patients were included in five studies. In two studies, oral clonidine (150 and 300 µg) or intrathecal clonidine (100 and 150 µg) was combined with local anaesthetics to evaluate the quality of sensory and motor block and postoperative analgesia. In a third study, the ant-idelirious effect of a single dose of clonidine (150 µg) given orally or intrathecally before operation was studied in 45 heavy alcohol abusers (daily ethanol intake of at least 60 g). The combination oflow doses of clonidine (15 and 30 µg) intrathecally with low dose bupivacaine was investigated during ambulatory herniorrhaphy. In a combined spinal-epidural anaesthesia study, a moderate dose of postoperative epidural clonidine (40 µg/h) was studied with or without low dose intrathecal clonidine (15µg); plain local anaesthetic was used as control. Sensory block was assessed by pin-prick, light touch, thermotest and transcutaneous electric stimulation; motor block was estimated by a modified Bromage scale. Pain intensity according to a Visual Analogue Scale (VAS) and analgesic request were recorded. AWS was assessed by the criteria of the Diagnostic and Statistical Manual of Mental Disorders.

Results: Intraoperatively, high doses of oral or intrathecal clonidine added to local anaesthetics almost doubled the time of sensory and motor block, and it was possible to reduce the dose of local anaesthetics without diminishing of the quality of spinal anaesthesia. Low doses of clonidine (15 µg) in combination with a low dose of bupivacaine significantly increased the spread of analgesia (4 dermatomes) without significantly prolonging the motor block. The same dose of clonidine combined with a high dose of bupivacaine significantly prolonged the sensory- and motor block by 36% and 18%, respectively Postoperatively, both oral and intrathecal clonidine prolonged time to first analgesic request. V AS score was acceptably low in all study groups. However, a high dose (150 µg) of intrathecal clonidine reduced postoperative 24-hour morphine consumption by 40% compared with control, while morphine-sparing was 55% when a low dose (15 µg) of intrathecal clonidine was combined with epidural clonidine. In ambulatory practice, low doses of intrathecal clonidine decreased analgesic requirements at home for up to 24 h after operation. In comparison with diazepam premedication, clonidine 150 µg, intrathecally or orally, reduced the incidence and degree of postoperative AWS in alcohol-dependent men (from 80 to 10%). The major side-effects of clonidine were hypotension and sedation, especially after oral administration. This hypotensive effect was also found after epidural clonidine infusion.

Conclusion: Clonidine, as an adjuvant to local anaesthetics, provided a higher quality of anaesthesia and postoperative analgesia and prevented postoperative alcohol withdrawal syndrome in alcohol abusers. Side effects such as hypotension and pronounced sedation postoperatively should be kept in mind if high doses of clonidine are used.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2004. 58 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 859
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-24053 (URN)3611 (Local ID)91-7373-830-1 (ISBN)3611 (Archive number)3611 (OAI)
Public defence
2004-10-08, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-11-01Bibliographically approved

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