British Journal of Anaesthesia, Vol 81, Issue 2 126-134, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
S. Armand, A. Langlade, A. Boutros, K. Lobjoit, C. Monrigal, R. Ramboatiana, A. Rauss and F. Bonnet
Clonidine, an alpha2 adrenoceptor agonist, has anti-hypertensive and
anti-nociceptive effects. It is commonly used in association with local
anaesthetics and opioids to enhance the quality and duration of extradural
analgesia in the postoperative period, and to decrease the incidence of
side effects. As a sole analgesic, it has seldom been used to relieve
postoperative pain. The dose of extradural clonidine to achieve good pain
relief without deleterious side effects remains undetermined. In order to
address this problem, we performed a computer search via two well-known
databases, Medline and Excerpta Medica, covering the period from 1985 to
September 1997. One hundred and fifty- nine articles were retrieved of
which 38 dealt with extradural clonidine and postoperative pain. All but 16
studies suffered from serious design flaws, such as lack of controls and/or
randomization, or inadequate statistical analysis. The data from these
studies were difficult to interpret because of the tremendous variation in
variables, especially dose of clonidine, level of extradural injection,
time of administration, type of anaesthesia, type of surgery, and reference
and rescue drugs. The simultaneous extradural use of local anaesthetics and
opioids further hindered data interpretation, and precluded any
meta-analysis. Proposals for a standard study design are made to help
comparison between studies involving extradural clonidine and postoperative
pain.
CLINICAL INVESTIGATIONS
Meta-analysis of the efficacy of extradural clonidine to relieve postoperative pain: an impossible task
Service d'Anesthesie-Reanimation, Hopital Cochin, Paris, France; Service d'Anesthesie-Reanimation, Hopital Tenon, Paris, France; Service d'Anesthesie-Reanimation, Centre Hospitalier InterCommunal, Creteil, France; Service d'Anesthesie-Reanimation, Hopital General, Saint-Germain-en- Laye, France; Service d'Anesthesie-Reanimation, Centre Hospitalier, Angers, France; Service d'Anesthesie-Reanimation, Centre Hospitalier, Blaye, France; Societe Roussel UCLAF, Romainville, France
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