The Effect of Preoperative Oral Clonidine on Shoulder Pain in Laparoscopic Cholecystectomy with General Anesthesia

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology and Intensive Care, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

2 Assistant Professor, Department of Anesthesiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran

3 Assistant Professor, Department of Anesthesiology and Intensive Care, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

4 General Practitioner, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background: Laparoscopic cholecystectomy is now the gold standard for the treatment of gallbladder disease. The study evaluated the clinical preoperative effects of oral administration of clonidine on shoulder pain after surgery in patients undergoing laparoscopic cholecystectomy with general anesthesia.Methods: 64 patients, scheduled for elective laparoscopic cholecystectomy, were recruited for this prospective randomized double-blind comparative study. They were randomly allotted to either placebo or clonidine group. Patients of the placebo group (n = 32) were premedicated with placebo, while those in the clonidine group (n = 32) were premedicated with oral clonidine 150 micrograms prior to anesthesia. The premedication was given 90 minutes before the anticipated time of induction of anesthesia. Postoperative shoulder pain was recorded based on visual analog scale (VAS), and cumulative analgesic requirement was reported in 24 hours.Findings: The postoperative VAS scores of shoulder pain were significantly less in clonidine group compared with placebo group at recovery period (P = 0.03). VAS scores were lower in clonidine group compared with the placebo group at 6, 12, and 24 hours postoperatively, but the differences were not significant (P > 0.05). Analgesic consumption was significantly less in clonidine group during 24 hours postoperatively (P = 0.02). Clonidine was not superior to placebo for attenuation of the hemodynamic responses to laryngoscopy and laparoscopy, but it increased the incidence of preoperative bradycardia (P = 0.02).Conclusion: A single oral dose of 150 micrograms clonidine, 90 minutes before induction of anesthesia for laparoscopic cholecystectomy, significantly reduces postoperative shoulder pain only at recovery period.

Keywords

References

  1. Vecchio R, MacFayden BV, Palazzo F. History of laparoscopic surgery. Panminerva Med 2000; 42(1): 87-90.
  2. Rawal N. Analgesia for day-case surgery. Br J Anaesth 2001; 87(1): 73-87.
  3. Ready LB, Oden R, Chadwick HS, Benedetti C, Rooke GA, Caplan R, et al. Development of an anesthesiology-based postoperative pain management service. Anesthesiology 1988; 68(1): 100-6.
  4. Robotham D, Macintyre PE. Joshi GP, White PF. Postoperative pain management: Day surgery. In: Rowbotham DJ, McIntyre P, editors. Clinical pain management: Acute pain. London, UK: Arnold; 2003. pp. 329–40.
  5. Alam M, Hoque H, Saifullah M. Port site and intraperitoneal infiltration of local anesthetics in reduction of postoperative pain after laparoscopic cholecystectomy. Medicine Today 2009; 22: 24-8.
  6. Paech MJ, Goy R, Chua S, Scott K, Christmas T, Doherty DA. A randomized, placebo-controlled trial of preoperative oral pregabalin for postoperative pain relief after minor gynecological surgery. Anesth Analg 2007; 105(5): 1449-53.
  7. Gayatri P. Post operative pain services. Indian J Anaesth 2005; 49(1): 17-9.
  8. Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: Effects of clonidine. J Am Coll Cardiol 1998; 32(5): 1389-96.
  9. Aho M, Lehtinen AM, Laatikainen T, Korttila K. Effects of intramuscular clonidine on hemodynamic and plasma beta-endorphin responses to gynecologic laparoscopy. Anesthesiology 1990; 72(5): 797-802.
  10. Aho M, Scheinin M, Lehtinen AM, Erkola O, Vuorinen J, Korttila K. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg 1992; 75(6): 932-9.
  11. Guo TZ, Jiang JY, Buttermann AE, Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology 1996; 84(4): 873-81.
  12. Tryba M, Gehling M. Clonidine--a potent analgesic adjuvant. Curr Opin Anaesthesiol 2002; 15(5): 511-7.
  13. Jamadarkhana S, Gopal S. Clonidine in adults as a sedative agent in the intensive care unit. J Anaesthesiol Clin Pharmacol 2010; 26(4): 439-45.
  14. De Vos H, Bricca G, De Keyser J, De Backer JP, Bousquet P, Vauquelin G. Imidazoline receptors, non-adrenergic idazoxan binding sites and α2-adrenoceptors in the human central nervous system. Neuroscience 1994; 59(3): 589-98.
  15. Hamilton CA. The role of imidazoline receptors in blood pressure regulation. Pharmacol Ther 1992; 54(3): 231-48.
  16. Guyenet PG, Cabot JB. Inhibition of sympathetic preganglionic neurons by catecholamines and clonidine: Mediation by an alpha-adrenergic receptor. J Neurosci 1981; 1(8): 908-17.
  17. Petros AJ, Wright RM. Epidural and oral clonidine in domiciliary control of deafferentation pain. Lancet 1987; 1(8540): 1034.
  18. Eisenach JC, Rauck RL, Buzzanell C, Lysak SZ. Epidural clonidine analgesia for intractable cancer pain: Phase I. Anesthesiology 1989; 71(5): 647-52.
  19. Ferit PA, Aydinli I, Akra S. Management of cancer pain with epidural clonidine. Reg Anesth 1992; 17(Suppl 3S): 173.
  20. Lund C, Hansen OB, Kehlet H. Effect of epidural clonidine on somatosensory evoked potentials to dermatomal stimulation. Eur J Anaesthesiol 1989; 6(3): 207-13.
  21. Eisenach JC, De Kock M, Klimscha W. alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology 1996; 85(3): 655-74.
  22. Payne FB, Ghia JN, Levin KJ, Wilkes NC. The relationship of preoperative and intraoperative factors on the incidence of pain following ambulatory surgery. Ambul Surg 1995; 3(3): 127-30.
  23. Alexander JI. Pain after laparoscopy. Br J Anaesth 1997; 79(3): 369-78.
  24. Sung CS, Lin SH, Chan KH, Chang WK, Chow LH, Lee TY. Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Acta Anaesthesiol Sin 2000; 38(1): 23-9.
  25. Prasad A, Bhattacharyya S, Biswas A, Saha M, Mondal S, Saha D. A comparative study of pre-operative oral clonidine and pregabalin on post-operative analgesia after spinal anesthesia. Anesth Essays Res 2014; 8(1): 41-7.
  26. Kholdebarin A, Jalili S, Godrati M, Rahimzadeh P, Rokhtabnak F, Sayarifard A et al. The effect of oral clonidine on hemodynamics and postoperative pain in laparoscopic cholecystectomy. J Anesth Pain 2014; 5(1): 45-53. [In Persian].
  27. Gupta K, Lakhanpal M, Gupta PK, Krishan A, Rastogi B, Tiwari V. Premedication with clonidine versus fentanyl for intraoperative hemodynamic stability and recovery outcome during laparoscopic cholecystectomy under general anesthesia. Anesth Essays Res 2013; 7(1): 29-33.
  28. Behdad S, Ayatollahi V, Yazdi AG, Mortazavizadeh A, Niknam F. Effect of oral low dose clonidine premedication on postoperative pain in patients undergoing abdominal hysterectomy: A randomized placebo controlled clinical trial. Rev Med Chir Soc Med Nat Iasi 2013; 117(4): 934-41.
Journal of Isfahan Medical School
Volume 37, Issue 545 - Serial Number 545
September and October 2019
Pages 1129-1135

Files

History

  • Receive Date: 09 June 2019
  • Revise Date:
  • Accept Date: 06 April 2022

Share

How to cite

Statistics