Postoperative analgesia for outpatient arthroscopic knee surgery with intraarticular clonidine

Intraarticular (IA) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Clonidine prolongs the duration of local anesthetics. We designed this study to determine whether clonidine added to an IA injection would result in an analgesic benefit. F ifty patients were randomly assigned to one of five groups that received cl onidine (either via the subcutaneous or IA route) or saline placebo with or without IA bupivacaine, as follows: Group 1 received 30 mt of 0.25% bupiva caine IA; Group 2 received 30 mt of 0.25% bupivacaine with clonidine (1 mu g/kg) IA; Group 3 received 30 mt of 0.25% bupivacaine IA and subcutaneous c lonidine (1 mu g/kg); Group 4 received 30 mt of 0.25% bupivacaine with epin ephrine (5 mu g/mL) IA; and Group 5 received clonidine (1 mu g/kg) in 30 mt of saline IA. The results of this study revealed a significant difference in analgesia from the IA administration of clonidine. The group who receive d a combination of IA bupivacaine and clonidine had a significantly decreas ed need for oral postoperative analgesics and an increased analgesic durati on (P < 0.0001). We conclude that IA clonidine improved comfort in patients undergoing knee arthroscopy. Implications: The intraarticular administrati on of clonidine along with bupivacaine results in a significant improvement in analgesia compared with either drug alone. There was an increased time to first analgesic request and a decreased need for postoperative analgesic s.