Premedication with low dose oral clonidine does not enhance postoperative analgesia of intrathecal morphine

  • Kelly V. Mayson
  • Ed A. Gofton
  • Keith G. Chambers
Reports Of Investigation


Purpose: A number of studies have demonstrated that perioperative intravenous, intrathecal, and epidural clonidine enhance postoperative analgesia. The results of previous studies on the usefulness of oral clonidine on enhancing postoperative analgesia have been mixed. The effect of a single preoperative dose of oral clonidine on postoperative analgesia was assessed in this study.

Methods: Forty-three male patients undergoing radical prostectomy were randomized to receive either 3 µg·kg−1 clonidine or placebopo 90 min prior to surgery. All patients received isobaric 15 mg bupivacaine and intrathecal 5 µg·kg−1 morphine, followed by a standardized general anesthetic, consisting of thiopental, sufentanil, rocuronium, isoflurane, oxygen and air. Postoperatively, PCA morphine use and visual analogue pain scores were recorded for the first 48 hr. The incidence and severity of side effects such as sedation, nausea, and pruritus were assessed, as well as patient satisfaction. Usage of PCA morphine was compared.

Results: There was no difference in total morphine requirements between the placebo and oral clonidine groups, nor in six hourly morphine usage (P=0.96). Second, there was no difference in visual analogue pain scores, or the incidence of side effects. Patient satisfaction was high in both groups and again, no differences between groups was noted.

Conclusions: Oral clonidine 3 µg·kg−1 as a premedication does not prolong the effect of intrathecal morphine: there was no difference in PCA morphine requirements (P=0.96). Clonidine did not effect the incidence or severity of nausea or pruritus.


Morphine Clonidine Spinal Anesthesia Sufentanil Rocuronium 


Objectif: Nombre d’études ont démontré que l’administration périopératoire, intraveineuse, intrathécale et péridurale de clonidine améliore l’analgésie postopératoire. Les études antérieures sur l’utilité de la clonidine orale en analgésie postopératoire ont donné des résultats variables. L’effet d’une dose préopératoire unique de clonidine orale sur l’analgésie postopératoire est évaluée dans la présente étude.

Méthode: Quarante-trois patients devant subir une prostatectomie radicale ont reçu, soit 3 µg·kg−1 de clonidine, soit un placebo po 90 min avant l’opération. Tous les patients ont reçu 15 mg de bupivacaïne isobare et 5 µg·kg−1 de morphine intrathécale suivis d’une anesthésie générale normale comprenant: thiopental, sufentanil, rocuronium, isoflurane, air et oxygène. Après l’opération. l’utilisation de morphine sous forme d’ACP et les scores de douleur à l’EVA ont été enregistrés pendant des 48 premières heures. L’incidence et la sévérité des effets secondaires, comme la sédation, les nausées, le prurit ont été évalués de même que la satisfaction du patient. L’utilisation de morphine ACP a été comparée.

Résultats: Il n’y a pas eu de différence intergroupe quant à la consommation totale de morphine et à la l’utilisation horaire de morphine mesurée à six reprises (P=0,96). De plus, il n’y a pas eu de différence de scores de douleur ou d’incidence d’effets secondaires. La satisfaction du patient était élevée dans les deux groupes, et encore une fois, sans différence intergroupe.

Conclusion: L’administration orale de 3 µg·kg−1 de clonidine comme prémédication ne prolonge pas l’effet de la morphine intrathécale: il n’y a pas de différence de consommation de morphine en ACP (P=0,96). La clonidine ne modified pas l’incidence ou la sévérité des nausées ou du prurit.


  1. 1.
    Bloor BC, Flacke WE. Reduction in halothane anesthetic requirement by clonidine, an alpha adrenergic agonist. Anesth Analg 1983; 61: 741–5.Google Scholar
  2. 2.
    Richards MJ, Skues MA, Jarvis AP, Prys-Roberts C Total i.v. anaesthetic with propofol and alfentanil: dose requirements for propofol and the effect of premedication with clonidine. Br J Anaesth 1990; 65: 157–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Ghignone M, Quinton L, Duke PC, Kehler CH, Calvillo O. Effects of clonidine on narcotic requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation. Anesthesiology 1986; 64: 36–42.PubMedCrossRefGoogle Scholar
  4. 4.
    Stühmeier K-D, Mainzer B, Cierpka J, Sandmann W, Tarnow J. Small, oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology 1996; 85: 706–12.PubMedCrossRefGoogle Scholar
  5. 5.
    Lui S, Chiu AA, Neal JM, Carpenter RL, Bainton BG, Gerancher JC. Oral clonidine prolongs lidocaine spinal anesthesia in human volunteers. Anesthesiology 1995; 82: 1353–9.CrossRefGoogle Scholar
  6. 6.
    Bernard J-M, Hommeril J-L, Passuti N, Pinaud M. Postoperative analgesia by intravenous clonidine. Anesthesiology 1991; 75: 577–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Filos KS, Goudas LC, Patroni O, Polzou V. Hemodynamic and analgesic profile after intrathecal clonidine in humans. A dose-response study. Anesthesiology 1994; 81: 591–601.PubMedCrossRefGoogle Scholar
  8. 8.
    Eisenach J, Detweiller D, Hood D. Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology 1993; 78: 277–87.PubMedCrossRefGoogle Scholar
  9. 9.
    Bernard J-M, Kick O, Bonnet F. Comparison of intravenous and epidural clonidine for postoperative patient-controlled analgesia. Anesth Analg 1995; 81: 706–12.PubMedCrossRefGoogle Scholar
  10. 10.
    De Kock M, Wiederkher P, Laghimiche A, Scholtes J-L. Epidural clonidine used as the sole analgesic agent during and after abdominal surgery. A dose-response study. Anesthesiology 1997; 86: 285–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Segal IS, Jarvis DJ, Duncan SR, White PF, Maze M. Clinical efficacy of oral-transdermal clonidine combinations during the perioperative period. Anesthesiology 1991; 74: 220–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Park J, Forrest J, Kolesar R, Bhola D, Beattie S, Chu C Oral clonidine reduces postoperative PCA morphine requirements. Can J Anaesth 1996; 43: 900–6.PubMedGoogle Scholar
  13. 13.
    Mikawa K, Nishina K, Maekawa N, Obara H. Oral clonidine premedication reduces postoperative pain in children. Anesth Analg 1996; 82: 225–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Benhamou D, Narchi P, Hamza J, Marx M, Peyrol M-T, Sembeil F. Addition of oral clonidine to postoperative patient-controlled analgesia with i.v. morphine. Br J Anaesth 1994; 72: 537–40.PubMedCrossRefGoogle Scholar
  15. 15.
    Ellis JE, Drijvers G, Pedlow S, et al. Premedication with oral and transdermal clonidine provides safe and efficacious postoperative sympatholysis. Anesth Analg 1994;79: 1133–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Goyagi T, Nishikawa T. Oral clonidine premedication enhances the quality of postoperative analgesia by intrathecal morphine. Anesth Analg 1996; 82: 1192–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Ota K, Namiki A, Iwasaki H, Takahashi I. Dose-related prolongation of tetracaine spinal anesthesia by oral clonidine in humans. Anesth Analg 1994; 79: 1121–5.PubMedGoogle Scholar
  18. 18.
    Ota K, Namiki A, Ujike Y, Takahashi I. Prolongation of tetracaine spinal anesthesia by oral clonidine. Anesth Analg 1992; 75: 262–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Singh H, Lui J, Gaines GY, White PF. Effect of oral clonidine and intrathecal fentanyl on tetracaine spinal block. Anesth Analg 1994; 79: 1113–6.PubMedGoogle Scholar
  20. 20.
    Motsch J, Gräber E, Ludwig K Addition of clonidine enhances postoperative analgesia from epidural morphine: a double-blind study. Anesthesiology 1990; 73: 1067–73.PubMedCrossRefGoogle Scholar
  21. 21.
    Mogensen T, Eliasen K, Kjlersen E, Vegger P, Nielsen IK, Kehlet H. Epidural clonidine enhances postoperative analgesia from a combined low-dose epidural bupivacaine and morphine regimen. Anesth Analg 1992; 75: 607–10.PubMedCrossRefGoogle Scholar
  22. 22.
    Anzai Y, Niskikawa T. Thoracic epidural clonidine and morphone for postoperative pain relief. Can J Anaesth 1995; 42: 292–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Capoyna G, Celleno D, Zangrillo A, Costantino P, Foresta S. Addition of clonidine to epidural morphine enhances postoperative analgesia after Cesarean delivery. Reg Anesth 1995; 20: 57–61.Google Scholar
  24. 24.
    Gan T, Glass P, Sigl J, et al. Women emerge from general anesthesia with propofol/alfentanil/nitrous oxide faster than men. Anesthesiology 1999; 90: 1283–7.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Kelly V. Mayson
    • 1
  • Ed A. Gofton
    • 1
  • Keith G. Chambers
    • 1
  1. 1.Department of AnesthesiaFrom the Vancouver General Hospital, University of British ColumbiaVancouverCanada

Personalised recommendations