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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 May;67(5):407-12

language: English

Improving postoperative analgesia after axillary brachial plexus anesthesia with 0.75% ropivacaine. A double-blind evaluation of adding clonidine

Casati A., Magistris L., Beccaria P., Cappelleri G., Aldegheri G., Fanelli G.

University of Milan IRCCS H. San Raffaele Department of Anesthesiology


Back­ground. The aim of ­this pros­pec­tive, ran­dom­ized, dou­ble-­blind ­study was to eval­u­ate the ­effects of add­ing 1 µg/kg clon­i­dine to 20 ml of ropiv­a­caine 0.75% for axil­lary bra­chi­al plex­us anes­the­sia.
Meth­ods. ­With Eth­i­cal Com­mit­tee approv­al and writ­ten con­sent, 30 ASA phys­i­cal stat­us I-II in-­patients, under­go­ing ­upper extrem­ity ortho­pe­dic pro­ce­dures ­were ran­dom­ly allo­cat­ed to ­receive axil­lary bra­chi­al plex­us ­block ­with 20 ml of 0.75% ropiv­a­caine ­alone (­group ropiv­a­caine, n = 15) or 0.75% ropiv­a­caine + 1 µg/kg clon­i­dine (­group ropiv­a­caine-clon­i­dine, n = 15). ­Nerve ­blocks ­were ­placed ­using a ­nerve stim­u­la­tor ­with the mul­ti­ple injec­tion tech­nique (stim­u­la­tion fre­quen­cy was 2 Hz; stim­u­la­tion inten­sity was ­decreased to ≤0.5 mA ­after ­each mus­cu­lar ­twitch; the anes­thet­ic vol­ume was equal­ly divid­ed ­among arm flex­ion, arm exten­sion, ­wrist flex­ion, and ­thumb adduc­tion). A blind­ed observ­er record­ed the ­time ­required to ­achieve sur­gi­cal ­block [­loss of pin­prick sen­sa­tion in the inner­va­tion are­as of the ­hand (C6-C8) ­with con­com­i­tant inabil­ity to ­move the ­wrist and ­hand] and ­first anal­ge­sic ­request.
­Results. No dif­fer­enc­es in demog­ra­phy, ­degree of seda­tion, periph­er­al oxy­gen sat­u­ra­tion, and hemo­dy­nam­ic var­i­ables ­were ­observed ­between the two ­groups. Readi­ness for sur­gery ­required 15 min (5-36 min) ­with 0.75% ropiv­a­caine and 20 min (5-30 min) ­with the ropiv­a­caine-clon­i­dine mix­ture. The ­degree of ­pain meas­ured at ­first anal­ge­sic ­request, and con­sump­tion of post­op­er­a­tive anal­ge­sics ­were sim­i­lar in the two ­groups; ­while ­first post­op­er­a­tive anal­ge­sic ­request ­occurred ­after 13.8 h (25th-75th per­cen­tiles: 9.1-13 h) in the ropiv­a­caine ­group and 15.2 h (25th-75th per­cen­tiles: 10.7-16 h) in the ropiv­a­caine-clon­i­dine ­group (p = 0.04).
Con­clu­sions. Add­ing 1 µg/kg clon­i­dine to 20 ml of ropiv­a­caine 0.75% for axil­lary bra­chi­al plex­us anes­the­sia pro­vid­ed a 3 h ­delay in ­first anal­ge­sic ­request post­op­er­a­tive­ly, with­out clin­i­cal­ly rel­e­vant ­effects on the ­degree of seda­tion and car­di­o­vas­cu­lar homeo­sta­sis.

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