The Efficacy and Safety of Epidural Infusions of Levobupivacaine With and Without Clonidine for Postoperative Pain Relief in Patients Undergoing Total Hip Replacement

Publisher Website
Google Scholar
Abstract
We assessed the efficacy and tolerability of epidural in- fusions of levobupivacaine, levobupivacaine plus clonidine, and clonidine for postoperative analgesia in 86 patients undergoing total hip replacement. For each group, an epidural cannula was inserted before surgery and 15 mL of 0.75% plain levobupivacaine was admin- istered. Three hours later, an epidural infusion (6 mL/h) of levobupivacaine 0.125% (L), levobupiva- caine 0.125% plus clonidine 8.3 mg/mL (LC) or clonidine alone (8.3 mg/mL) (C) was initiated. Mor- phine consumption was recorded for the following 24 h as were visual analog pain scores and the degree of sen- sory and motor blockade. The mean (median) mor- phine consumption was lowest in the combination group (LC),14 (7) mg; higher in the clonidine group (C), 23 (21) mg; and highest in the levobupivacaine group (L), 37 (36) mg (P 5 0.022). The median times until the first request for analgesia which were 2.9, 5.9, and 12.5 h for Groups L, C, and LC, respectively (P # 0.01). There were no statistical differences among the groups re- garding the maximum degree of postoperative motor blockade. On average, the systolic blood pressure in the two clonidine groups was slightly lower than in those from the levobupivacaine group. We conclude that the epidural administration of a combination of levobupi- vacaine plus clonidine is well tolerated and gives better analgesia than either drug used alone. (Anesth Analg 2000;91:393-7)