Intraoperative Clonidine in Spine Surgery: A Randomised Controlled Trial

Area of Science:

• Anesthesiology
• Pain Management
• Neurosurgery

Background:

• Post-operative pain is a significant concern for patients undergoing spine surgery.
• Clonidine, an alpha-2 agonist, has demonstrated analgesic properties that may be beneficial in managing surgical pain.

Purpose of the Study:

• To evaluate the efficacy of a single intraoperative intravenous dose of clonidine in reducing post-operative opioid consumption and pain intensity in spine surgery patients.
• To assess the impact of clonidine on side effects such as post-operative nausea and vomiting (PONV), sedation, and hypotension.

Main Methods:

• A randomized, double-blinded, placebo-controlled trial was conducted with 120 patients undergoing spine surgery.
• Patients received either intraoperative intravenous clonidine (3 μg/kg) or a placebo.
• Primary outcome was opioid consumption within 3 hours post-surgery; secondary outcomes included pain intensity, PONV, sedation, and hypotension.

Main Results:

• No significant difference was found in opioid consumption within the first 3 hours post-surgery between the clonidine and placebo groups (5 mg vs. 10 mg morphine equivalents).
• Pain intensity at rest upon arrival at the post-anaesthesia care unit (PACU) was similar between groups (4 vs. 3 on the pain scale).
• Hypotension occurred more frequently in the clonidine group (24 patients) compared to the placebo group (13 patients).

Conclusions:

• A single intraoperative intravenous dose of clonidine does not effectively reduce post-operative opioid consumption or pain intensity in patients undergoing spine surgery.
• The increased incidence of hypotension in the clonidine group suggests a potential safety concern without clear clinical benefit for pain relief.