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ANALGESIA

Clonidine and Analgesic Duration After Popliteal Fossa Nerve Blockade: Randomized, Double-Blind, Placebo-Controlled Study

Jacques T. YaDeau, MD, PhD^*, Vincent R. LaSala, MD^*, Leonardo Paroli, MD, PhD^*, Richard L. Kahn, MD^*, Kethy M. Jules-Elysée, MD^*, David S. Levine, MD, Barbara L. Wukovits, RN, BSN, C^*, and Jane Y. Lipnitsky, BA^*

From the *Department of Anesthesiology and Foot and Ankle Service, Department of Orthopedic Surgery at Hospital for Special Surgery, Weill Medical College of Cornell University, New York City, NY.

Address correspondence to Jacques T. Ya Deau, MD, PhD, Hospital for Special Surgery, 535 E 70th St., New York, NY 10011. Address e-mail to yadeauj{at}hss.edu.

Abstract

BACKGROUND: We tested the hypothesis that 100 µg clonidine added to 0.375% bupivacaine would prolong the duration of analgesia from popliteal fossa nerve blockade.

METHODS: Ninety-nine patients scheduled for hospital admission after foot or ankle surgery entered this randomized, double-blind, placebo-controlled trial. Patients received a popliteal fossa block (nerve stimulator technique, via the posterior approach) using 30 mL 0.375% bupivacaine, with epinephrine. Patients were randomized to receive no clonidine, 100 µg clonidine IM, or 100 µg clonidine with bupivacaine for the popliteal block. Patients also received a combined spinal-epidural anesthetic, a saphenous nerve block, and postoperative IV patient-controlled analgesia. The primary outcome was patient-reported duration of analgesia.

RESULTS: Duration of analgesia was statistically longer in the block clonidine group (18 ± 6 h for clonidine with bupivacaine vs 14 ± 7 h for IM clonidine and 15 ± 7 h for control, P = 0.016 for control vs clonidine with bupivacaine). Pain scores, analgesic use, and side effects attributable to pain management were similar among groups.

CONCLUSIONS: Clonidine significantly prolongs the analgesic duration after popliteal fossa nerve blockade with bupivacaine.