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Pre-surgical drug might ease recovery, reduce pain in peds

Tuesday March 11, 2014
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Administering clonidine before surgery could be a good option for controlling postop pain and also could reduce the child’s anxiety, according to a recent evidence review from the Cochrane Library.

The study’s lead author, Allan Cyna, PhD, senior consultant anesthesiologist at Women’s and Children’s Hospital at the University of Adelaide in Australia, said the review confirmed what he and his colleagues had observed in practice. According to Cyna, those observations drove researchers to design the study.

The review found clonidine given at 4 micrograms/kg had a low number of side effects compared with other pain medications. Two potential side effects were noted — bradycardia and hypotension.

To determine whether clonidine was effective in relieving postop pain, the researchers compared the results of 11 studies, conducted in Sweden, China, the United States, Greece, Canada, Turkey, Japan, Jordan and Brazil, involving 742 children younger than 18. In four of the trials, clonidine was compared to a dummy treatment or no treatment, while six trials compared the drug with the medication midazolam and in one trial, with fentanyl.

In the trials comparing clonidine to a dummy treatment, the need for additional pain relief after surgery decreased when children were given clonidine at a 4 micrograms/kg dose before the procedure. The researchers found trials comparing clonidine with midazolam had similar results. The single trial comparing clonidine with fentanyl showed no statistically significant difference in need for additional pain relief after surgery, they found.

“There were no significant side effects of clonidine that were reported such as severe hypotension, bradycardia, or excessive sedation requiring intervention,” the authors wrote in the abstract. “However, several studies used atropine prophylactically with the aim of preventing such adverse effects.”

Because the existing studies are small and have varying methodologies, the authors called for further research “to determine under what conditions clonidine premedication is most effective in providing postoperative pain relief in children.”

Study abstract: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009633.pub2/abstract

To see what else is trending in Pain Management, visit www.Nurse.com/Pain-Management.


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