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Comparative assessment of the anaesthetic and analgesic effects of intramuscular and epidural clonidine in humans

Canadian Journal of Anaesthesia volume 43, pages 1195–1202 (1996)Cite this article

Abstract

Purpose

The aim of the study was to assess and compare in analogous controlled experimental conditions, the anaesthetic sparing and analgesic effects of the same dose of clonidine administered by the intramuscular (im) and epidural (ep) routes.

Methods

We used a randomized, double blind and placebo controlled protocol. Sixty patients undergoing abdominal hysterectomy were distributed into three groups who, 30 min before surgical incision, received: 300 μg ep clonidine plus im saline; ep saline plus 300 μg im clonidine; or ep and im saline (ss). General anaesthesia was maintained with 60% N2O in O2, and isoflurane administered at concentrations to maintain mean arterial pressure (MAP) and heart rate (HR) within 20% of basal values. Isoflurane requirements (mass spectrometry), cardiovascular variables (MAP, HR), and plasma concentrations of glucose, cortisol and prolactin were evaluated at critical time points. In the recovery room (RR), sedation (Ramsay) and pain intensity (VAS) were estimated at the time of analgesia request (TAR).

Results

Intramuscular and ep clonidine decreased isoflurane requirements similarly by about 85% (P < 0.001). Patients in the ep group had lower MAP (P < 0.03) and HR (P < 0.001) than in the im group, but im and ep clonidine similarly blunted the plasma prolactin increase induced by intubation. In RR, ep but not im clonidine (P < 0.01) induced postoperative analgesia demonstrated by a prolonged TAR 80.8 ± 7.3 (ep) 35.9 ± 3.2 (im) and 44.5 ±5.1 (ss) min and a lower VAS (P < 0.05).

Conclusions

Epidural and intramuscular clonidine decreased isoflurane requirements similarly, but only the epidural route provided postoperative analgesia, suggesting a spinal site for the analgesic action.

Résumé

Objectif

’Evaluer et comparer dans des conditions expérimentales identiques, l’effet d’épargne anesthésique et analgésique d’une même dose de clonidine administrée par la voie intramusculaire (IM) ou épidurale (Ép).

Méthodes

Un protcole aléatoire, en double aveugle et contrôlé avec placebo était utilisé. Soixante patientes programmées pour une hystérectomie abdominale étaient réparties en trois groupes qui, 30 min avant l’incision de la peau, recevaient: de la clonodine 300 pg ép et du sol. phys. im; du sol. phys ép et de la clonidine 300 μg im; ou du sol. phys. ép et im (ss). L’anesthésie générale était maintenue avec N2O 60% dans O2 et des concentrations d’isoflurane suffisantes pour maintenir la pression artérielle moyenne (PAM) et la fréquence cardiaque (FC) à 20% des valeurs initiales. Les besoins en isoflurane (spectrornétrie de masse), les paramètres cardiaques (PAM, FC) et la glycémie, la cortisolémie et la prolactinémie étaient évalués au moment des intervalles cruciaux. En salle de réveil, la sédation (Ramsay) et l’intensité de la douleur (EVA) étaient évalués par la durée de l’intervalle précédant la demande d’analgésique (IPDA).

Résultats

La clonidine IM et Ép a diminué également les besoins en isoflurane par environ 85% (P < 0,001). Les patientes du groupe ép avaient des PAM plus basses (P < 0,03) et des FC plus lentes (P < 0,001) que celles du groupe im, mais la clonidine im et ép a diminué également l’augmentation de la concentration plasmatique de prolactine provoquée par l’intubation. À la salle de réveil, la clonidine ép contrairement à la clonidine im (P < 0,01) a induit l’analgésie postopératoire comme le démontrait un IPDA prolongé à 80,8 ± 7,3 (ép), 35,9 ± 3,2 (im) et 44,5 ±5,1 (ss) min et une EVA moins élevée.

Conclusion

La clonidine épidurale et intramusculaire diminue les besoins en isoflurane également, mais seule la voie épidurale procure une analgésie postopératoire, ce qui suggère un site d’action rachidien pour l’analgésie.

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Affiliations

  1. Department of Anaesthesiology, Hospital Universitario del Mar, Anaesthesiology Research Unit, IMIM, Paseo Marítimo 25, 08003, Barcelona, Spain

    Enric Samsó, Jordi Vallés, Olga Pol, Lluis Gallart & Margarita M. Puig

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  1. Enric Samsó
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  2. Jordi Vallés
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  3. Olga Pol
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  4. Lluis Gallart
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  5. Margarita M. Puig
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Additional information

Partially supported by a Grant from the Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo, Madrid, Spain (94/1380)

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Samsó, E., Vallés, J., Pol, O. et al. Comparative assessment of the anaesthetic and analgesic effects of intramuscular and epidural clonidine in humans. Can J Anaesth 43, 1195–1202 (1996). https://doi.org/10.1007/BF03013424

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Key words

  • anaesthetics inhalational: isoflurane
  • anaesthetic techniques: inhalational
  • analgesia: postoperative
  • sympathetic nervous system: pharmacology, clonidine