This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Baker, A. Articles by Chiari, A. I. Search for Related Content PubMed PubMed Citation Articles by Baker, A. Articles by Chiari, A. I. Related Collections Postanesthetic Care Unit Regional Anesthesia Pain Pharmacology

---

TECHNOLOGY, COMPUTING, AND SIMULATION

Intrathecal Clonidine for Postoperative Analgesia in Elderly Patients: The Influence of Baricity on Hemodynamic and Analgesic Effects

Amir Baker, MD^*, Walter Klimscha, MD^*, James C. Eisenach, MD, Xin-Hui Li, PhD, Eckart Wildling, MD^*, Wolfgang A. Menth-Chiari, MD, and Astrid I. Chiari, MD^*

*Department of Anesthesiology and General Intensive Care, University of Vienna, Vienna, Austria; Department of Anesthesiology and Center for the Study of Pharmacologic Plasticity in the Presence of Pain, Wake Forest University School of Medicine, Winston-Salem, North Carolina; and Department of Traumatology, University of Vienna, Vienna, Austria

Address correspondence to Astrid I. Chiari, MD, Department of Anesthesiology and General Intensive Care, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Address e-mail to astrid.chiari{at}univie.ac.at Reprints will not be available from the authors.

Intrathecal (IT) clonidine is an effective analgesic, but it also produces hemodynamic depression and sedation which are likely to be related to IT clonidine’s cephalad spread within the cerebrospinal fluid. We hypothesized that IT clonidine’s side effects could be reduced without compromising the duration and quality of analgesia by injecting clonidine IT in a hyperbaric solution and elevating the patient’s trunk. We prospectively randomized 30 elderly patients to receive IT 150 µg of either isobaric (ISO) or hyperbaric (HYPER) clonidine for postoperative analgesia after surgical repair of traumatic hip fracture. Hemodynamics, IV fluid administration, visual analog pain scores, sedation scores, and clonidine cerebrospinal fluid levels were recorded at fixed intervals. Patients in the ISO group required significantly more crystalloid fluid administration (median, 2500 mL; range, 1500–3000 mL) than those in the HYPER group (median, 1500; range, 500–3000 mL) to maintain adequate arterial blood pressure (P < 0.01). Also, the decrease in heart rate was significantly more pronounced in the ISO than in the HYPER group (P < 0.01). The duration of analgesia was significantly larger in the ISO (median, 400 min; range, 115–400 min) than in the HYPER (median, 265 min; range, 205–400 min) group (P < 0.05). Sedation scores did not differ between groups. We conclude that increasing the baricity of IT clonidine solution in the conditions of our experiment reduces hemodynamic side effects but also analgesia from IT administered clonidine.

IMPLICATIONS: In elderly patients after surgical repair of traumatic hip fracture, intrathecal hyperbaric clonidine reduces hemodynamic side effects but also the quality and duration of postoperative analgesia compared with isobaric clonidine.

This article has been cited by other articles:

				M. Wolff, P. Heugel, G. Hempelmann, A. Scholz, J. Muhling, and A. Olschewski Clonidine reduces the excitability of spinal dorsal horn neurones Br. J. Anaesth., March 1, 2007; 98(3): 353 - 361. [Abstract] [Full Text] [PDF]