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REGIONAL ANESTHESIA AND PAIN MEDICINE

Small-Dose Clonidine Prolongs Postoperative Analgesia After Sciatic-Femoral Nerve Block with 0.75% Ropivacaine for Foot Surgery

Department of Anesthesiology, University of Milan, Milan, Italy

Address correspondence and reprint requests to Dr. A. Casati, Anesthesiology Department, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Address e-mail to casati.andrea{at}hsr.it

To evaluate the effects of adding small-dose clonidine to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I and II patients undergoing hallux valgus repair under combined sciatic-femoral nerve block were randomly allocated in a double-blinded fashion to receive block placement with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n = 15) or 0.75% ropivacaine plus 1 µg/kg clonidine (group Ropivacaine-Clonidine, n = 15). Hemodynamic variables, oxygen saturation, and levels of sedation, as well as the time required to achieve surgical block and time to first analgesic request, were recorded by a blinded observer. Time to surgical blockade required 10 min in both groups. Patients in the Ropivacaine-Clonidine group were more sedated than patients in the Ropivacaine group only 10 min after block placement. No differences in oxygen saturation and hemodynamic variables, degree of pain measured at first analgesic request, and consumption of postoperative analgesics were observed between the two groups. The mean time from block placement to first request for pain medication was shorter in group Ropivacaine (13.7 h; 25th–75th percentiles: 11.8–14.5 h) than in group Ropivacaine-Clonidine (16.8 h; 25th–75th percentiles: 13.5–17.8 h) (P = 0.038). We conclude that adding 1 µg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects.

Implications: This prospective, randomized, double-blinded study demonstrated that, when providing combined sciatic-femoral nerve block for hallux valgus repair, the addition of 1 µg/kg clonidine to 0.75% ropivacaine prolongs the duration of postoperative analgesia by 3 h, with only a slight and short-lived increase in the degree of sedation and no hemodynamic adverse effects.

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