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REGIONAL ANESTHESIA

Adding Clonidine to the Induction Bolus and Postoperative Infusion During Continuous Femoral Nerve Block Delays Recovery of Motor Function After Total Knee Arthroplasty

Andrea Casati, MD^*, Federico Vinciguerra, MD, Gianluca Cappelleri, MD, Giorgio Aldegheri, MD, Guido Fanelli, MD^*, Marta Putzu, MD^*, and Jacques E. Chelly, MD

*Department of Anesthesiology, University of Parma, Parma, Italy; Department of Anesthesiology, Vita-Salute University of Milano, Milano, Italy; and Department of Anesthesiology, University School of Medicine, Pittsburgh, Pennsylvania

Address correspondence and reprint requests to Andrea Casati, MD, Department of Anesthesiology, Policlinico Di Parma, Via Gramsci 14-43100, Parma, Italy. Address e-mail to acasati.{at}ao.pr.it.

We evaluated the effects of adding clonidine for continuous peripheral nerve infusions. Sixty patients undergoing total knee arthroplasty under combined single-injection sciatic block and continuous femoral infusion were randomly allocated to three groups: block induction with 0.75% ropivacaine followed by 0.2% ropivacaine (group control; n = 20); block induction with 0.75% ropivacaine and 1 µg/kg clonidine followed by 0.2% ropivacaine (group cloni-bolus; n = 20), and block induction with 0.75% ropivacaine and 1 µg/kg clonidine followed by 0.2% ropivacaine with 1 µg/mL clonidine (group cloni-infusion; n = 20). After surgery, continuous femoral infusion was provided with a patient-controlled infusion pump (basal infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min). The median (range) onset time of surgical block was 15 min (5–30 min) in group control, 10 min (5–35 min) in group cloni-bolus, and 10 min (5–30 min) in group cloni-infusion (P = 0.07). No differences were reported among groups in the degree of pain measured with the visual analog scale. The total consumption of local anesthetic solution after a 24-h infusion was 170 mL (144–220 mL) in group control, 169 mL (144–260 mL) in group cloni-bolus, and 164 mL (144–248 mL) in group cloni-infusion (P = 0.51); after the second day of infusion, total consumption was 168 mL (144–200 mL) in group control, 156 mL (144–288 mL) in group cloni-bolus, and 150 mL (144–210 mL) in group cloni-infusion (P = 0.48). Hemodynamic profiles and sedation were similar in the three groups. Motor function impairment after 48 h of infusion was observed in 27% of cloni-infusion patients but in only 6% of both the control and cloni-bolus groups (P = 0.05). We conclude that adding clonidine 1 µg/mL to local anesthetic for continuous femoral nerve block does not improve the quality of pain relief but has the potential for delaying recovery of motor function.

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				Y.-S. Huang, L.-C. Lin, B. K. Huh, M. J. Sheen, C.-C. Yeh, C.-S. Wong, and C.-T. Wu Epidural Clonidine for Postoperative Pain After Total Knee Arthroplasty: A Dose-Response Study Anesth. Analg., May 1, 2007; 104(5): 1230 - 1235. [Abstract] [Full Text] [PDF]

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