Intrathecal clonidine slightly improves the analgesic effects of intrathecal morphine, though increases hypotension (harm ratio 1.8).

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• E Engelman and C Marsala.
• Department of Anaesthesia, CUB Hopital Erasme, Route de Lennik 808, 1070 Brussels, Belgium. eengelma@ulb.ac.be
• Br J Anaesth. 2013 Jan 1;110(1):21-7.

BackgroundClonidine may be used along with intrathecal morphine for single-dose postoperative analgesia in adults. The efficacy of this is not clear.MethodsA meta-analysis was performed for two endpoints of efficacy: the time to first postoperative analgesia request and the amount of systemic morphine used during the first 24 h after operation. A Bayesian inference supporting direct statements about the probability of the magnitude of an effect was also used. The frequency of the five adverse events (postoperative nausea or vomiting, sedation, respiratory depression, pruritus, and hypotension) was analysed.ResultsClonidine increased the duration of analgesia by 1.63 h [95% confidence interval (CI): 0.93-2.33]. There is a 90% probability that clonidine increases the duration of postoperative analgesia by more than 75 min compared with morphine alone. Clonidine reduced the amount of postoperative morphine by a mean of 4.45 mg (95% CI: 1.40-7.49 mg). There is a probability of 90% to obtain a decrease >2.3 mg but only 35% to obtain a decrease >5 mg. The incidence of hypotension was the only adverse event increased by clonidine (odds ratio 1.78; 95% CI: 1.02-3.12).ConclusionsThe addition of clonidine to intrathecal morphine extends the time to first analgesia and decreases the amount of morphine used. However, as the effects are small, and the results heavily influenced by a study in which intrathecal fentanyl was also given, this must be balanced with the increased frequency of hypotension.

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