| Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. | |
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MedLine Citation:
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PMID: 19602964 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. The authors searched for randomized placebo-controlled trials testing the impact of adding clonidine to local anesthetics for peripheral single-injection nerve or plexus blocks in adults undergoing any surgery (except eye) without general anesthesia. Twenty trials (1,054 patients, 573 received clonidine) published 1992-2006 tested plexus (14 brachial, 1 cervical) and nerve blocks (2 sciatic/femoral, 1 midhumeral, 1 ilioinguinal/iliohypogastric, 1 ankle). Clonidine doses ranged from 30 to 300 microg; most patients received 150 microg. Clonidine prolonged the duration of postoperative analgesia (weighted mean difference 122 min; 95% confidence interval [CI] 74-169), sensory block (weighted mean difference 74 min; 95% CI 37-111), and motor block (weighted mean difference 141 min; 95% CI 82-199). In a subgroup of patients receiving an axillary plexus block, these effects were independent of whether clonidine was added to an intermediate or a long-acting local anesthetic. Clonidine increased the risk of arterial hypotension (odds ratio 3.61; 95% CI 1.52-8.55; number-needed-to-harm 11), orthostatic hypotension or fainting (odds ratio 5.07; 95% CI 1.20-21.4; number-needed-to-harm 10), bradycardia (odds ratio 3.09; 95% CI 1.10-8.64; number-needed-to-harm 13), and sedation (odds ratio 2.28; 95% CI 1.15-4.51; number-needed-to-harm 5). There was a lack of evidence of dose-responsiveness for beneficial or harmful effects. Clonidine added to intermediate or long-acting local anesthetics for single-shot peripheral nerve or plexus blocks prolongs duration of analgesia and motor block by about 2 h. The increased risk of hypotension, fainting, and sedation may limit its usefulness. Dose-responsiveness remains unclear. |
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Authors:
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Daniel M Pöpping; Nadia Elia; Emmanuel Marret; Manuel Wenk; Martin R Tramèr |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Review |
Journal Detail:
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Title: Anesthesiology Volume: 111 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2009 Aug |
Date Detail:
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Created Date: 2009-07-24 Completed Date: 2009-08-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 406-15 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology and Intensive Care, University Hospital Münster, Münster, Germany. poppind@uni-muenster.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adjuvants, Anesthesia*
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adverse effects Anesthetics, Local* Axilla Clonidine* / adverse effects Humans Motor Neurons / drug effects Nerve Block* Pain, Postoperative / drug therapy Peripheral Nerves / drug effects* Randomized Controlled Trials as Topic Sensory Receptor Cells / drug effects Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Adjuvants, Anesthesia; 0/Anesthetics, Local; 4205-90-7/Clonidine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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