Premedication of Oral Clonidine 2mcg/kg and 4mcg/kg for Analgesic and Pressure Response During First Twenty-four Hours After Upper Abdominal Surgery: A Comparative Study
Keywords:hepatobiliary surgery, gastrectomy, esophagectomy, hepatictomy, and whipples operations
Traditionally postoperative period analgesia was maintained by opoids and which frequently increasethe hospital stay time and cost by delayed bowel movement and others side effects. on the other handupper abdominal surgery is very much painful, usually Opiods are used as good analgesic, but havesome adverse effect and addiction effect; anaesthesiologists want to reduce its requirements. In upperabdominal surgery adequate analgesia, stable haemodynamic, early bowel movement, free from nauseaand vomiting is wanted, as a part of multimodal analgesic approach, premedication by clonidine is veryimportant for it analgesic, angiolytic and sedative properties. Alpha two (α–2) adrenoreceptor agonist,Clonidine exerts central sympatholytic effect for 8 to 10 hours as its half life is 9-12 h. So thatpremedication with oral clonidine causes reduction of anxiety, reduction of perioperative analgesicdrugs and also reduction of anaesthetic doses. In addition, clonidine increases cardiac baroreceptorreflex sensitivity to increase in systolic blood pressure, and thus stabilizes blood pressure. Clonidine israpidly and almost completely absorbed after oral administration with a time to maximum plasmaconcentration of between 1.5 and 2 hr and elimination half-life of 8 to 12 hr. But clonidine producesanalgesia in a dose dependent manner, achieving complete pain relief for up to 5 hours without sensoryor motor block at large doses (oral 7000 to 900 mcg) however large doss were associated withdisadvantage including hypotension, bradycardia and transient sedation. It also reported thatclonidine 150mcg intravenous (I/V) produce a similar analgesic effect to morphine 5mg in patient afterorthopedic surgery. Because of its dose, route, and surgical variation it is very much important tospecify the dose for upper abdominal surgery.The primary aim of this study to compare the effects of clonidine premedication at different doses (2 &4mcg/kg) on postoperative analgesia and hemodynamic status in upper abdominal surgery with largeincision area. (like- hepatobiliary surgery, gastrectomy, esophagectomy, hepatictomy, and whipplesoperations).
JBSA 2022; 35 (2) : 17-21