Clonidine for remifentanil-induced hyperalgesia: a double-blind randomized, placebo-controlled study of clonidine under intra-operative use of remifentanil in elective surgery of the shoulder

• Published in: Schmerz (Berlin, Germany) Vol. 25; no. 3; p. 290
• Main Authors: Schlimp, C J, Pipam, W, Wolrab, C, Ohner, C, Kager, H I, Likar, R
• Format: Journal Article
• Language: German
• Published: Germany 01.06.2011
• Subjects: Adult; Analgesia, Patient-Controlled; Analgesics - therapeutic use; Analgesics, Opioid - administration & dosage; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - adverse effects; Arthroscopy; Austria; Clonidine - therapeutic use; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Hyperalgesia - chemically induced; Hyperalgesia - drug therapy; Male; Middle Aged; Morphine - administration & dosage; Pain Measurement; Pain, Postoperative - drug therapy; Piperidines - administration & dosage; Piperidines - adverse effects; Preanesthetic Medication; Shoulder - surgery; Shoulder Injuries; Shoulder Pain - surgery
• ISSN: 1432-2129
• DOI: 10.1007/s00482-011-1058-8

In the postoperative period, α2-adrenergic agonists have an opioid sparing effect. In a previous, experimental study, it was also shown that clonidine attenuates remifentanil-induced hyperalgesia. In this study, we examined under clinical conditions whether early administration of a single dose of clonidine can inhibit remifentanil-induced hyperalgesia in patients undergoing elective surgery of the shoulder and with continuous intraoperative use of remifentanil. In this study 40 patients received double-blind and randomized either 150 µg clonidine or placebo intravenously before skin incision. Anaesthesia was maintained with propofol and remifentanil (0.23 ± 0.09 µg/kg body weight/min) and morphine (0.1 mg/kg body weight) was administered 20 min before incision closure. Postoperatively, the patients were given a patient-controlled analgesia pump (PCA) with morphine. Overall morphine consumption as well as overall assessment of pain with the visual analogue scale in the first 24 h postoperatively did not differ significantly between the groups. Isolated pain scores at 12 h and 24 h were significantly enhanced in the clonidine group (p<0.05). An early single dose of 150 µg of clonidine did not reduce the postoperative morphine consumption and pain scores in patients undergoing elective surgery of the shoulder with remifentanil/propofol-based anaesthesia. After the effect of clonidine has presumably subsided the pain can even increase, therefore further studies with repetitive doses of clonidine should be carried out.