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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
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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

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