The effectiveness of clonidine as an analgesic in paediatric adenotonsillectomy

Abstract

Purpose: To compare the analgesic effects of preoperative oral clonidine with intraoperative intravenous fentanyl in children undergoing tonsillectomy or adenotonsillectomy. Methods: This randomized, controlled, double-blind study of 36 ASA I-II children, age 7-12 yr undergoing adenotonsillectomy was conducted at a tertiary care paediatric teaching hospital. Either 4 lug'kg q clonidine p0 was given 60-90 rain preoperatively or 3/~g-kg -s fentanyl iv was given intraoperatively. Postoperatively visual analog pain scores (VAS) were recorded at rest and on swallowing every I 0 rain for the first 30 rain and then every I 5 min for two hours. Morphine 0.05 mg'kg -I iv was given for VAS _>5. If >3 doses were required, 1.5 mg.kg -I codeine p0 and 20 mg'kg q acetaminophen p0 were given. Sedation and anxiety scores were recorded preoperatively. Haemodynamic changes, blood loss, recovery scores, and the incidence of vomiting, hypotension, and airway obstruction were recorded. Results: Children who received donidine had a higher incidence of preoperative sedation (63%) than those receiving fentanyl (6%). Preinduction mean arterial pressure was lower in the clonidine group but required no intervention. VAS scores were similar throughout the observation period. There was no difference either in the number of morphine or codeine rescue doses administered or in the incidence of side effects. Conclusion: Oral clonidine is an effective analgesic and sedative for children undergoing tonsillectomy or adenotonsillectomy. Objectif : Comparer les effets analg&iques de l'administration orale de clonidine prEop&atoire et de fentanyl intraveineux perop&atoire chez des enfants devant subir une amygdalectomie ou une adEno-amygdalectomie. M~thode : Cette Etude randomisEe, contr61Ee et ~ double insu a porte sur 36 enfants ASA MI, ~gEs de 7 ~ 12 arts, devant subir une adEno-amygdalectomie dans un h6pital universitaire de soins pEdiatriques tertiaires. On a administrE 4 ug-kg "i de clonidine po 60-90 min avant l'intervention ou 3 ugkg ~ de fentanyl iv au cours de l'intervention. Les niveaux de douleur ont EtE enregistr& apt& rop&ation, ~ raide de l'EcheIle visuelle analogue (EVA), au repos et lors de la dEglutition ~ toutes les I 0 rain pendant les 30 premieres min et ~ toutes les 15 min pendant les deux heures suivantes. On a administrE 0,0S mg'kg -I de morphine iv pour des scores ~S ~ I'EVA. Si plus de 3 doses &aient n&essaires, on a donne aussi 1,5 mg-kg I de codeine po et 20 mg'kg i d'acEtaminophEne po. Avant l'intervention, on a enregistrE les niveaux de sedation et d'anxiEtE. Les changements hEmodynamiques, les pertes sanguines, les niveaux de rEcupEration et l'incidence de vomissements, d'hypotension et d'obstruction du conduit a&ien ont EtE not&. R~u]tats : Les enfants qui ont re~u de la clonidine ont pr&entE une plus grande incidence de sedation prEop&a-toire (63 %) que ceux qui ont re~u du fentanyl (6 %). Avant l'induction de l'anesth&ie, la tension art&ielle moyenne &ait plus basse dans le groupe qui avait regu de la clonidine, mais...

ORAL CLONIDENE IN CHILDREN: EFFICACY AS PREMEDICANT AND EFFECT ON POSTOPERATIVE RECOVERY. (COMPARISON OF TWO DIFFERENT DOSES 3µg/kg AND 4µg/kg)

“…Clonidine 3µg/kg used by Ramesh et al showed sedation effect comparable to diazepam (10) . Clonidine 4µg/kg used by Mikawa et al, Remier et al, Batra et al and Malde et al (3,5,8,10,13,14) . They found that clonidine 4µg/kg had better sedation, anxiolysis and attenuation of haemodynamic response than diazepam.…”

Clonidina associada à morfina e midazolam em crianças submetidas à ventilação mecânica: estudo aleatório, duplamente encoberto e placebo controlado

“…A ineficácia apresentada pela clonidina, por via enteral, neste estudo, em potencializar os efeitos sedativos em crianças submetidas à VM, poderia ser atribuída a: a) Não efetividade do fármaco: vários estudos já demonstraram a eficácia da clonidina, tanto como sedativos 2,4,7, 18,20,[21][22][23][24][25][26][27][28] , como no tratamento da abstinência 2-4,5,9, 12,16,17,19,29 . Em alguns estudos, quando utilizada para sedação leve, a clonidina teve resultados comparáveis ao fentanil, evitando doses extras de sedativos 21 . Em apenas um estudo a clonidina e o placebo não apresentaram diferenças 6 .…”

Anesthetic management of pediatric adenotonsillectomy

“…Clonidine is an effective analgesic in this situation, 11,19 although over-sedation would be a concern in patients with OSAS. Preoperative acetaminophen seems to be a useful intervention for minor procedures such as myringotomy.…”