Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T18:26:58.324Z Has data issue: false hasContentIssue false
  • English
  • Français

Clonidine added to bupivacaine enhances and prolongs analgesia after brachial plexus block via a local mechanism in healthy volunteers

Published online by Cambridge University Press:  23 December 2004

D. Hutschala ,
H. Mascher ,
L. Schmetterer ,
W. Klimscha ,
T. Fleck ,
H.-G. Eichler  and
E. M. Tschernko
D. Hutschala
Affiliation:
University of Vienna, Department of Cardiothoracic Anesthesia, Vienna, Austria
H. Mascher
Affiliation:
Pharm-analyt Laboratory, Baden, Austria
L. Schmetterer
Affiliation:
University of Vienna, Department of Clinical Pharmacology and Institute of Medical Physics, Vienna, Austria
W. Klimscha
Affiliation:
University of Vienna, Department of Anesthesiology, Vienna, Austria
T. Fleck
Affiliation:
University of Vienna, Department of Cardiothoracic Surgery, Vienna, Austria
H.-G. Eichler
Affiliation:
University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
E. M. Tschernko
Affiliation:
University of Vienna, Department of Clinical Pharmacology and the Department of Cardiothoracic Anaesthesia & CCM, Vienna, Austria
Get access

Abstract

Summary

Background and objective: The addition of clonidine to local anaesthetics enhances pain relief after peripheral nerve block, but the site of action is unproven.

Methods: Seven healthy volunteers underwent three brachial block procedures using bupivacaine 0.25% 1 mg kg−1 + epinephrine 1 : 200 000 (=local analgesic) in a randomized, double-blind cross-over fashion: (a) control treatment: local analgesic with 0.9% sodium chloride solution for the block and an intramuscular injection of saline; (b) intramuscular treatment: local analgesic with 0.9% NaCl for block and an intramuscular injection of clonidine 2 μg kg−1 and (c) block treatment: local analgesic with clonidine 2 μg kg−1 for block and an intramuscular injection of saline.

Results: The onset and duration of complete blockade (sensory/motor/temperature) was evaluated in the four nerve regions of the hand and forearm. Additionally, sedation score, blood pressure, heart rate and plasma clonidine concentrations were determined. The median duration of complete sensory blockade was 270 min (range 0–600) for block treatment compared to 0 min (range 0–480) for intramuscular treatment (P < 0.05) and 0 min (range 0–180) for control treatment (P < 0.05). Motor and temperature blockade exhibited similar results. Administration of clonidine was associated with sedation and a decrease in heart rate and blood pressure independent of the route of administration. Plasma clonidine concentrations were lower for block compared to the intramuscular treatment.

Conclusions: The admixture of clonidine to bupivacaine plus epinephrine prolongs and enhances brachial plexus blockade. Lower clonidine plasma concentrations for block treatment strongly suggest a local effect.

Keywords

ADRENERGIC AGONISTS, adrenergic α-agonistsANAESTHESIA, CONDUCTION, nerve blockBRACHIAL PLEXUS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 3 , March 2004 , pp. 198 - 204
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Racle JP, Benkhadra A, Poy JY, Gleizal B. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg 1987; 66: 442–446.Google Scholar
Bonnet F, Brun-Buisson V, Saada M, Boico O, Rostaing S, Touboul C. Dose-related prolongation of hyperbaric tetracaine spinal anesthesia by clonidine in humans. Anesth Analg 1989; 68: 619–622.Google Scholar
Huntoon M, Eisenach J, Boese P. Epidural clonidine after cesarean section. Appropriate dose and effect of prior local anesthetic. Anesthesiology 1992; 76: 187–193.Google Scholar
Eledjam JJ, Deschodt J, Viel EJ, et al. Brachial plexus block with bupivacaine effects of added alpha-adrenergic agonists: comparison between clonidine and epinephrine. Can J Anesth 1991; 38: 870–875.Google Scholar
Gaumann DM, Forster A, Griessen M, Habre W, Poinsot O, Della Santa D. Comparison between clonidine and epinephrine admixture to lidocaine in brachial plexus block. Anesth Analg 1992; 75: 69–74.Google Scholar
Syngelin FJ, Dangoisse M, Bartholomee S, Gouverneur JM. Adding clonidine to mepivacaine prolongs the duration of anesthesia and analgesia after axillary plexus block. Reg Anesth 1992; 17: 148–150.Google Scholar
Bernard J-M, Macaire P. Dose-range effects of clonidine added to lidocaine for brachial plexus block. Anesthesiology 1997; 87: 277–284.Google Scholar
Lynch IIIC. Depression of myocardial contractility in vitro by bupivacaine, etidocaine, and lidocaine. Anesth Analg 1986; 65: 551–559.Google Scholar
Moller RA, Covino BG. Cardiac electrophysiologic effects of lidocaine and bupivacaine. Anesth Analg 1988; 67: 107–114.Google Scholar
Tanz RD, Heskett T, Loehning RW. Comparative cardiotoxicity of bupivacaine and lidocaine in the isolated perfused mammalian heart. Anesth Analg 1984; 63: 549–556.Google Scholar
Tschernko EM, Klepetko H, Gruber E, et al. Clonidine added to the anesthetic solution enhances analgesia and improves oxygenation after intercostal nerve blockade for thoracotomy. Anesth Analg 1998; 87: 107–111.Google Scholar
Bromage PR. Mechanism of action. In: Bromage PR, ed. Epidural Analgesia.Philadelphia, USA: WB Saunders, 1978: 119–159.
Murray S, Waddell KA, Davies DS. The measurement of clonidine in human plasma and urine by combined gas chromatography mass spectrometry with ammonia chemical ionization. Biomed Mass Spectrom 1981; 8: 500–502.Google Scholar
Lanz E, Theiss D, Jankovic D. The extent of blockade following various techniques of brachial plexus block. Anesth Analg 1983; 62: 55–58.Google Scholar
Culebras X, Van Gessel E, Hoffmeyer P, Gamulin Z. Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes. Anesth Analg 2001; 92: 199–204.Google Scholar
Lavoie J, Martin R, Tetrault J-P, Cote DJ, Colas MJ. Axillary plexus block using a peripheral nerve stimulator: single or multiple injections. Can J Anesth 1992; 39: 538–546.Google Scholar
Singelyn FJ, Gouverneur J-M, Robert A. A minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block. Anesth Analg 1996; 83: 1046–1050.Google Scholar
Erlacher W, Schuschnig C, Koinig H, Marhofer P, Melischek M, Kapral S. Clonidine as adjuvant for mepivacaine, propivacaine and bupivacaine in axillary, perivascular brachial plexus block. Can J Anaesth 2001; 48: 522–525.Google Scholar
El Saied AH, Steyn MP, Ansermino JM. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anesth 2000; 47: 962–967.Google Scholar
Nishikawa T, Dohi S. Clinical evaluation of clonidine added to lidocaine solution for epidural anesthesia. Anesthesiology 1990; 73: 853–859.Google Scholar
Ota K, Namiki A, Hiroshi I, Takahashi I. Dose-related prolongation of tetracaine spinal anesthesia by oral clonidine in humans. Anesth Analg 1994; 79: 1121–1135.Google Scholar
Brimijoin S, Helland L. Rapid retrograde transport of dopamine-β-hydroxylase as examined by the stop-flow technique. Brain Res 1976; 102: 217–228.Google Scholar
Gaumann DM, Brunet PC, Jirounek P. Hyperpolarizing afterpotentials in C fibers and local anesthetic effects of clonidine and lidocaine. Pharmacology 1994; 48: 21–29.Google Scholar
Khasar SG, Green PG, Chou B, Levine JD. Peripheral nociceptive effects of alpha 2-adrenergic receptor agonists in the rat. Neuroscience 1995; 66: 427–432.Google Scholar
Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984–1995). Anesthesiology 1996; 85: 655–674.Google Scholar
Reid JL, Barber ND, Davies DS. The clinical pharmacology of clonidine: relationship between plasma concentration and pharmacological effect in animals and man. Arch Int Pharmacodyn Ther 1980; 44 (Suppl): 11–16.Google Scholar
De Vos H, Bricca G, De Keyser J, De Backer J-P, Bousquet P, Vauquelin G. Imidazoline receptors, non-adrenergic idazoxam binding sites and alpha 2-adrenoceptors in the human central nervous system. Neuroscience 1994; 59: 589–598.Google Scholar
Hamilton CA. The role of imidazoline receptors in blood pressure regulation. Pharmacol Ther 1992; 54: 231–248.Google Scholar
Eisenach JC, Lysak SZ, Viscomi CM. Epidural clonidine analgesia following surgery: phase I. Anesthesiology 1989; 71: 640–646.Google Scholar