Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.029
Brazilian Journal of Anesthesiology
Original Investigation

Comparison between intravenous and intratecal clonidine for postoperative analgesia of patients submitted to laparoscopic cholecystectomy: randomized clinical trial

Comparação entre clonidina intravenosa e intratecal na analgesia pós-operatória de pacientes submetidos à colecistectomia laparoscópica: ensaio clínico randomizado

Christiane Rodrigues da Silva; Cinthya Iamile Frithz Brandão de Oliveira; Juscimar Carneiro Nunes

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Abstract

Introduction and objectives: Alpha2 adrenergic agonists, such as clonidine, are used as adjuvants during anesthesia due to their analgesic, sedative, and cardiovascular effects. The objective of the present study was to compare the effect of clonidine administered intravenously and intrathecally on the postoperative pain score of patients undergoing laparoscopic cholecystectomy, according to the route of administration and postoperative opioid consumption.

Methods: This randomized clinical trial, blind to patients and evaluator, assessed 60 patients, candidates for elective laparoscopic cholecystectomy under standardized general anesthesia techniques. Patients were randomly allocated into three groups (20 in each group): Control Group (CG), Intrathecal Clonidine Group (ITCG), and Intravenous Clonidine Group (IVCG). The primary outcome was the comparison of pain, Blood Pressure (BP) and Heart Rate (HR) scores among groups. The secondary outcome was report of adverse effects such as bradycardia, hypotension and sedation, and the need for rescue medication.

Results: The mean age was 37.2 ± 8.2 years, and the mean body mass was 28.3 ± 3.6 kg.m-2. Regarding HR (p = 0.003) and pain (p = 0.027), patients in ITCG and CG showed a different profile over time, with CG showing higher consumption of morphine as rescue medication (p = 0.005).

Conclusion: The administration of intrathecal and intravenous clonidine in low doses can reduce hemodynamic parameters and decrease postoperative requirement of analgesics. Further studies should investigate the ideal dose and method.

Keywords

Laparoscopic cholecystectomy, Anesthesia, Clonidine, Analgesia, Clinical trial

Resumo

Introdução e objetivos: Os agonistas α2 adrenérgicos, como a clonidina, são utilizados como adjuvantes durante a anestesia devido a seus efeitos analgésicos, sedativos e de estabilização cardiovascular. Este estudo teve como objetivo comparar o efeito da clonidina endovenosa e intratecal no escore de dor pós-operatória em pacientes submetidos à colecistectomia laparoscópica, de acordo com a via de administração e o consumo de opioides no pós-operatório.

Métodos: Este ensaio clínico randomizado, com paciente e avaliador encobertos, foi conduzido com 60 pacientes, candidatos à colecistectomia laparoscópica eletiva sob anestesia geral, com técnicas padronizadas, divididos aleatoriamente em três grupos (20 em cada grupo): controle (GC), clonidina intratecal (GCIT) e clonidina intravenosa (GCIV). O desfecho primário foi a comparação dos escores de dor, pressão arterial (PA) e frequência cardíaca (FC) entre os grupos; e secundário, a presença de efeitos adversos como bradicardia, hipotensão e sedação, e a necessidade de medicação de resgate.

Resultados: A média de idade foi de 37,2 ± 8,2 anos e a massa corporal média foi de 28,3 ± 3,6 kg / m2. No que se refere à FC (p = 0,003) e à dor (p = 0,027), os grupos GCIT e GC apresentaram comportamento distinto ao longo do tempo, com maior uso de morfina como medicação de resgate no GC (p = 0,005).

Conclusão: A administração de clonidina intratecal e endovenosa em baixas doses é capaz de reduzir os parâmetros hemodinâmicos e a necessidade de analgésicos no pós-operatório. Estudos futuros devem investigar dose e método ideais.

Palavras-chave

Colecistectomia Laparoscópica, Anestesia, Clonidina, Analgesia, Ensaio clínico

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Submitted date:
12/11/2019

Accepted date:
03/16/2021

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Braz J Anesthesiol

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