Spinal anaesthesia with clonidine: pain relief and earlier mobilisation after open nephrectomy – a randomised clinical trial

• Published in: Journal of international medical research Vol. 50; no. 9; p. 3000605221126883
• Main Authors: Thurm, Mascha, Hultin, Magnus, Johansson, Göran, Dahlin, Britt-IngerKröger, Winsö, Ola, Ljungberg, Börje
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.09.2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Anaesthesiology; anestesiologi; Clinical trials; Kidney cancer; Pain management; Patient satisfaction; Prospective Clinical Research Report; radical nephrectomy; mobility index; length of stay; Spinal anaesthesia; epidural analgesia; mobilisation; randomised clinical trial; partial nephrectomy; pain score
• ISSN: 0300-0605; 1473-2300; 1473-2300
• DOI: 10.1177/03000605221126883

Objectives Early mobilisation and effective pain management after open nephrectomy for renal cell carcinoma often include epidural analgesia (EDA), requiring an infusion pump and a urinary catheter, thus impeding mobilisation. Spinal anaesthesia (SpA) may be an alternative. This randomised clinical trial evaluated whether SpA improves analgesia and facilitates mobilisation over EDA and which factors influence mobilisation and length of stay (LOS). Methods Between 2012 and 2015, 135 patients were randomised and stratified by surgical method to either SpA with clonidine or EDA. Mobility index score (MobIs), pain scale, patient satisfaction questionnaire, and LOS were the main outcome measures. Results SpA patients exhibited an increase in MobIs significantly earlier than EDA patients. Among SpA patients >50% reached MobIs ≥13 by postoperative day 3, while 29% of EDA patients never reached MobIs ≥13 before discharge. SpA patients had higher maximum pain scores on postoperative days 1 and 2, but both groups had similar patient satisfaction. One day before discharge, 36/64 SpA versus 22/67 EDA patients (56% and 33%, respectively) were opioid-free. SpA patients were discharged significantly earlier than EDA patients. Conclusions SpA facilitates postoperative pain management and is associated with faster mobilisation and shorter LOS. The trial was registered at ClinicalTrials.org (ID-NCT02030717).