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PAIN MEDICINE

Intrathecal and Oral Clonidine as Prophylaxis for Postoperative Alcohol Withdrawal Syndrome: A Randomized Double-Blinded Study

I. Dobrydnjov, MD^*, K. Axelsson, MD PhD^*, L. Berggren, MD PhD^*, J. Samarütel, MD PhD, and B. Holmström, MD PhD^*

*Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; and Tartu University Hospital, Tartu, Estonia

Address correspondence and reprint requests to I. Dobrydnjov, Department of Anesthesiology and Intensive Care, University Hospital, SE 701 85 Örebro, Sweden. Address e-mail to igor.dobrydnjov{at}orebroll.se

In this study, we evaluated the effect of intrathecal and oral clonidine as supplements to spinal anesthesia with lidocaine in patients at risk of postoperative alcohol withdrawal syndrome (AWS). We hypothesized that clonidine would have a prophylactic effect on postoperative AWS. Forty-five alcohol-dependent patients (daily ethanol intake >60 g) scheduled for transurethral resection of the prostate were double-blindly randomized into three groups. All patients received hyperbaric lidocaine 100 mg intrathecally. The diazepam group (DiazG) was premedicated with diazepam 10 mg orally; the intrathecal clonidine group (Clon^i/tG) received a placebo (saline) tablet and clonidine 150 µg intrathecally; and the oral clonidine group (Clon^p/oG) received clonidine 150 µg orally. For patients diagnosed with AWS, the Clinical Institute Withdrawal Assessment for Alcohol, revised scale, was used. Twelve patients in the DiazG had symptoms of AWS, compared with two in the Clon^i/tG and one in the Clon^p/oG. The median Clinical Institute Withdrawal Assessment for Alcohol, revised scale, score was 12 in the DiazG versus 1 in the clonidine-treated groups. Two patients in the DiazG had severe delirium. Patients receiving oral clonidine had a slightly decreased mean arterial blood pressure 6–12 h after spinal anesthesia (P < 0.05); patients in the DiazG had a hyperdynamic circulatory reaction 24–72 h after surgery. In conclusion, preoperative clonidine 150 µg, intrathecally or orally, prevented significant postoperative AWS in ethanol-dependent patients.

IMPLICATIONS: In this randomized, double-blinded study, clonidine 150 µg both intrathecally and orally prevented postoperative alcohol-withdrawal symptoms in alcohol-dependent men. The effect was superior to that with a single dose of diazepam 10 mg orally.

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