The effectiveness of clonidine as an analgesic in paediatric adenotonsillectomy

Purpose: To compare the analgesic effects of preoperative oral clonidine wi th intraoperative intravenous fentanyl in children undergoing tonsillectomy or adenotonsillectomy. Methods: This randomized, controlled, double-blind study of 36 ASA I-II chi ldren, age 7-12 yr undergoing adenotonsillectomy was conducted at a tertiar y care paediatric teaching hospital. Either 4 mu g k(-1) clonidine po was g iven 60-90 min preoperatively or 3 mu g.kg(-1) fentanyl iv was given intrao peratively. Postoperatively visual analog pain scores (VAS) were recorded a t rest and on swallowing every 10 min for the first 30 min and then every 1 5 min for two hours. Morphine 0.05 mg.kg(-1) iv was given for VAS greater t han or equal to 5, If > 3 doses were required, 1.5 mg.kg(-1) codeine eo and 20 mg.kg(-1) acetaminophen po were given. Sedation and anxiety scores were recorded preoper atively, Haemodynamic changes, blood loss, recovery score s, and the incidence of vomiting, hypotension, and airway obstruction were recorded. Results: Children who received clonidine had a higher incidence of preopera tive sedation (63%) than those receiving fentanyl (6%), Preinduction mean a rterial pressure was lower in the clonidine group but required no intervent ion. VAS scores were similar throughout the observation period. There was n o difference either in the number of morphine or codeine rescue doses admin istered or in the incidence of side effects. Conclusion: Oral clonidine is an effective analgesic and sedative for child ren undergoing tonsillectomy or adenotonsillectomy.