1 / 22

Clonidine premedication for postoperative analgesia in children: a meta-analysis

Clonidine premedication for postoperative analgesia in children: a meta-analysis. Dr Paul Lambert Dr Nick Knight ANZCA-HKCA CSM, May 14th 2011. Rationale for review Clonidine premedication in children. Postoperative pain A problem in search of a solution Premedication

rufina
Download Presentation

Clonidine premedication for postoperative analgesia in children: a meta-analysis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Clonidine premedication for postoperative analgesia in children: a meta-analysis Dr Paul Lambert Dr Nick Knight ANZCA-HKCA CSM, May 14th 2011

  2. Rationale for reviewClonidine premedication in children Postoperative pain A problem in search of a solution Premedication ? Analgesic efficacy postoperatively Has a number of other objectives May have adverse effects Clonidine may be useful for postoperative analgesia No systematic review, specifically of clonidine's analgesic efficacy, to date

  3. Clonidine: Background α-adrenergic agonist Preferential α2 activity Useful/desirable characteristics Analgesic Sedative Anxiolytic Administered via a variety of routes Side-effects Hypotension Bradycardia Excessive sedation

  4. Clonidine premedication reviewStudy aims To determine the effects of clonidine premedication, in children, on postoperative pain

  5. Clonidine premedication reviewPrimary Outcomes Incidence of analgesia use in recovery unit postoperative period Incidence of sedation requiring intervention

  6. Clonidine premedicationSecondary outcomes Analgesia outcomes Pain-free in PACU Requiring opioid Pain scores Time to first analgesic dose Adverse effects Hypotension or bradycardia PONV Shivering Agitation or confusion HDU or ICU admission

  7. Literature Search • Electronic databases • Medline, EMBASE, CENTRAL • Bibliographies of retrieved studies • Search strategy • Fields- clinical trials- clonidine- paediatric anaesthesia - pain and other postoperative complications

  8. Clonidine premedication: Included studies

  9. Description of Studies Heterogeneity Types of comparisons Dose and route of clonidine Comparator Type of surgery Outcome measure Risk of bias Primary Outcome Measure Additional analgesia requirement: Only one study (Riemer 1999) explicitly separates analgesia use in recovery unit from use on ward

  10. Supplementary analgesiaClonidine (any dose) vs placebo or no treatment

  11. Supplementary analgesiaLow or high dose clonidine vs placebo or no treatment

  12. Clonidine can replace opioid Reimer 1998 (clonidine 4 µg/kg vs. fentanyl 3 µg/kg): No difference in opioid requirement postoperatively (RR 0.89 [0.56-1.42]) Hackmann 2003 (clonidine 4µg/kg vs. placebo): No difference in additional analgesia requirements postoperatively, but more fentanyl given to placebo group intraoperatively

  13. Supplementary analgesiaClonidine 4 µg/kg vs midazolam 0.5 mg/kg

  14. Clonidine vs midazolam

  15. Adverse effects No study reported excessive (hazardous) sedation Low incidence of Bradycardia Hypotension (Note: Bergendahl 2004, Georgiou 1999, Kuvaki 1998, Mikawa 1996, Nishina 2000 all gave atropine prophylaxis)

  16. Study limitations Heterogeneity between studies Inverse correlation of pain scores with sedation scores – are we looking at analgesia or sedation?

  17. Implications for practice Clonidine premedication at adequate dose does appear to lower analgesia requirements postoperatively in children Low incidence of serious side-effects

  18. Future work Either small studies, each tailored to a particular type of surgery… …or a large trial with subgroup analysis Multiple outcome measures

  19. Acknowledgements Formal project supervisor Allan M Cyna Co-investigators Philippa Middleton Nicholas Knight Other assistance T. Hackmann B. Kuvaki E. Reimer A. Schmidt Cochrane Collaboration

  20. Thank you Any questions? lambert@internode.on.net

More Related