8/4/2019 Meta Anal Clonidine

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Clonidine premedication for postoperative analgesia in children: a meta-analysis

Paul Lambert1, Nicholas Knight

2, Philippa Middleton

3, Allan Cyna

4

1Department of Anaesthetics, Flinders Medical Centre, Bedford Park, South Australia, Australia,

2Department of Anaesthetics, Royal Adelaide Hospital, Adelaide, South Australia, Australia,

3Australian

Research Centre for Health of Women and Babies (ARCH), Robinson Institute, University of Adelaide,Adelaide, South Australia, Australia,

4

Introduction: Postoperative pain is a significant problem in paediatric surgery. Inadequate analgesiaincreases patient distress in the short term and may have long-term adverse effects. Thealpha-2adrenergic agonist, clonidine, has been used as a premedication for anxiolysis, sedation, analgesia, andreduction of heart rate and blood pressure. However, its use can result in excessive sedation,hypotension, and bradycardia

Department of Women's Anaesthesia, Women's and Children'sHospital, North Adelaide, South Australia, Australia

1. The overall benefits of clonidine as a premedication over other commonly

used drugs, such as midazolam, have in recent years been the subject of review2

and meta-analysis3

Methods: This study was conducted according to Cochrane methodology. We searched for randomizedor quasi-randomized controlled trials of children < 18 years presenting for general anaesthesia. Weincluded any study where clonidine premedication was administered and compared with any otherintervention or no treatment. Primary outcomes were: the requirement for supplementary analgesia, eitherin the post-anaesthesia care unit (PACU) or subsequently, and excessive sedation requiring intervention.Secondary outcome measures included: pain scores, opioid use, haemodynamic outcomes, and timeuntil discharge from PACU and the hospital. Meta-analysis was performed using a random effects,Mantel-Haenszel model.

.This systematic review aims to evaluate the postoperative analgesia effects of clonidine premedicationwhen compared to any other treatment, placebo or usual care.

Results: Database search found 179 studies of which 39 papers were retrieved in full. Ten studiesinvestigating 729 children were subsequently found suitable for inclusion. Four compared clonidine withplacebo or no treatment, five compared clonidine with midazolam and one compared clonidinepremedication with fentanyl. Clonidine was associated with a non-significant reduction in the incidence of

postoperative analgesia use in the three trials with data, suitable for meta-analysis, investigating thiscomparison - RR 0.28 [95%CI 0.05,1.45]. There was a significant reduction in the one study comparingclonidine with midazolam presenting dichotomous data, RR 0.25 [95% CI 0.12, 0.53]. There was nodifference in incidence of postoperative analgesia use in the one study comparing clonidine with fentanyl,RR 0.71, [95%CI 0.18, 2.89].

Conclusion: Preliminary findings suggest that clonidine decreased the incidence of postoperativeanalgesia use when compared with midazolam and possibly placebo or no treatment. However there wasno difference in postoperative analgesia use when clonidine was compared with fentanyl.

References:1. Nishina K, et al. (1999) Paediatr. Anaesth. 9:187-202.2. Bergendahl, H., et al. (2006) Acta Anaesthesiol. Scand. 50: 135-143.3. Dahmani, S., et al. (2010) Acta. Anaesthesiol. Scand. 54: 397-402.