Document Detail


The efficacy and safety of epidural infusions of levobupivacaine with and without clonidine for postoperative pain relief in patients undergoing total hip replacement.
MedLine Citation:
PMID:  10910855     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We assessed the efficacy and tolerability of epidural infusions of levobupivacaine, levobupivacaine plus clonidine, and clonidine for postoperative analgesia in 86 patients undergoing total hip replacement. For each group, an epidural cannula was inserted before surgery and 15 mL of 0.75% plain levobupivacaine was administered. Three hours later, an epidural infusion (6 mL/h) of levobupivacaine 0.125% (L), levobupivacaine 0.125% plus clonidine 8.3 microg/mL (LC) or clonidine alone (8.3 microg/mL) (C) was initiated. Morphine consumption was recorded for the following 24 h as were visual analog pain scores and the degree of sensory and motor blockade. The mean (median) morphine consumption was lowest in the combination group (LC),14 (7) mg; higher in the clonidine group (C), 23 (21) mg; and highest in the levobupivacaine group (L), 37 (36) mg (P = 0.022). The median times until the first request for analgesia which were 2. 9, 5.9, and 12.5 h for Groups L, C, and LC, respectively (P < or = 0. 01). There were no statistical differences among the groups regarding the maximum degree of postoperative motor blockade. On average, the systolic blood pressure in the two clonidine groups was slightly lower than in those from the levobupivacaine group. We conclude that the epidural administration of a combination of levobupivacaine plus clonidine is well tolerated and gives better analgesia than either drug used alone. Implications: In patients undergoing total hip replacement, the addition of the alpha(2)-adrenergic agonist clonidine to epidural infusions of levobupivacaine significantly improved postoperative analgesia.
Authors:
K R Milligan; P N Convery; P Weir; P Quinn; D Connolly
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  91     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-08-15     Completed Date:  2000-08-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  393-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Anaesthesia, Musgrave Park Orthopaedic Hospital, Belfast, Northern Ireland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Analgesia, Epidural*
Analgesics / administration & dosage*
Analgesics, Opioid / therapeutic use
Anesthetics, Local / administration & dosage*
Arthroplasty, Replacement, Hip*
Bupivacaine / administration & dosage*
Clonidine / administration & dosage*
Female
Humans
Male
Morphine / therapeutic use
Pain Measurement
Pain, Postoperative / drug therapy,  prevention & control*
Chemical
Reg. No./Substance:
0/Analgesics; 0/Analgesics, Opioid; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 4205-90-7/Clonidine; 57-27-2/Morphine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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