Low-dose intrathecal clonidine combined with sufentanil as analgesic drugsin abdominal gynecological surgery

Study Objectives: To determine whether a low dose of spinal clonidine eithe r alone or combined with sufentanil would provide effective analgesia follo wing abdominal surgery as a supplement to bupivacaine spinal anesthesia. Design: Randomized double-blind study. Setting: Gynecological surgery, teaching hospital. Patients: 73 ASA physical status I and II patients undergoing gynecological abdominal surgery with spinal anesthesia. Interventions: Patients were randomly assigned to one of four groups and pr ospectively studied to examine anesthesia, analgesia, and adverse effects. The control group, received saline as the test drug; the sufentanil group r eceived 10 mu g of sufentanil; the clonidine group received 30 mu g of clon idine; and the sufentanil/clonidine group received 5 mu g of sufentanil plu s 15 mu g of clonidine. All groups received intrathecal 15 mg of bupivacain e (3 mL) plus the intrathecal test drug (2 mL). The concept of visual analo g scale (VAS) was introduced. All patients were premedicated with intraveno us midazolam. Rescue analgesics were available. Measurements and Main Results: The groups were demographically the same. Se nsory block to pinprick at 10 min was higher for clonidine and sufentanil/c lonidine groups compared to the control group (P < 0.02). Anesthetic time ( Bromage score 2) was also longer for clonidine and sufentanil/clonidine gro ups compared to the control and sufentanil groups (p < 0.05). Time to first rescue analgesics was shorter in the control group compared to the other g roups (p < 0.02). The number of IM diclofenac dose injections in 24 hours w as higher in the control group compared to all other groups (p < 0.05). The incidence of adverse effects and ephedrine consumption were similar among groups. Conclusions: Intrathecal 15- and 30-mu g clonidine doses expanded the anest hesia sensory block and duration of motor block, and provided analgesia. (C ) 2000 by Elsevier Science Inc.