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The impact of neuraxial clonidine on postoperative analgesia and perioperative adverse effects in women having elective Caesarean section-a systematic review and meta-analysis.

Publication ,  Journal Article
Allen, TK; Mishriky, BM; Klinger, RY; Habib, AS
Published in: Br J Anaesth
February 2018

Neuraxial clonidine improves postoperative analgesia in the general surgical population. The efficacy and safety of neuraxial clonidine as a postoperative analgesic adjunct in the Caesarean section population still remains unclear. This systematic review and meta-analysis aims to evaluate the effect of perioperative neuraxial clonidine on postoperative analgesia in women having Caesarean section under neuraxial anaesthesia. We included randomized controlled trials comparing the analgesic efficacy of the perioperative administration of neuraxial clonidine alone or in combination with a local anaesthetic and/or opioids in women having elective Caesarean section under neuraxial anaesthesia when compared with placebo. PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE were searched until February 2017. Eighteen studies were included in the meta-analysis. Neuraxial clonidine reduced 24 h morphine consumption [mean difference (MD): -7.2 mg; 95% confidence interval (CI): -11.4, -3.0 mg; seven studies] and prolonged time to first analgesic request (MD: 135 min; 95% CI: 102, 168 min; 16 studies) when compared with the control group. Neuraxial clonidine increased intraoperative hypotension [odds ratio (OR): 2.849; 95% CI: 1.363, 5.957], intraoperative sedation (OR: 2.355; 95% CI: 1.016, 5.459), but reduced the need for intraoperative analgesic supplementation (OR: 0.224; 95% CI: 0.076, 0.663). The effect of clonidine on intraoperative bradycardia, intraoperative and postoperative nausea and vomiting, postoperative sedation, and pruritus were inconclusive. Neuraxial clonidine did not negatively impact neonatal umbilical artery pH or Apgar scores. This review demonstrates that neuraxial clonidine enhances postoperative analgesia in women having Caesarean section with neuraxial anaesthesia, but this has to be balanced against increased maternal adverse effects.

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Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

February 2018

Volume

120

Issue

2

Start / End Page

228 / 240

Location

England

Related Subject Headings

  • Pregnancy
  • Postoperative Complications
  • Pain, Postoperative
  • Infant, Newborn
  • Humans
  • Female
  • Clonidine
  • Cesarean Section
  • Anesthesiology
  • Anesthesia, Obstetrical
 

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Allen, T. K., Mishriky, B. M., Klinger, R. Y., & Habib, A. S. (2018). The impact of neuraxial clonidine on postoperative analgesia and perioperative adverse effects in women having elective Caesarean section-a systematic review and meta-analysis. Br J Anaesth, 120(2), 228–240. https://doi.org/10.1016/j.bja.2017.11.085
Allen, T. K., B. M. Mishriky, R. Y. Klinger, and A. S. Habib. “The impact of neuraxial clonidine on postoperative analgesia and perioperative adverse effects in women having elective Caesarean section-a systematic review and meta-analysis.Br J Anaesth 120, no. 2 (February 2018): 228–40. https://doi.org/10.1016/j.bja.2017.11.085.
Allen, T. K., et al. “The impact of neuraxial clonidine on postoperative analgesia and perioperative adverse effects in women having elective Caesarean section-a systematic review and meta-analysis.Br J Anaesth, vol. 120, no. 2, Feb. 2018, pp. 228–40. Pubmed, doi:10.1016/j.bja.2017.11.085.
Journal cover image

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

February 2018

Volume

120

Issue

2

Start / End Page

228 / 240

Location

England

Related Subject Headings

  • Pregnancy
  • Postoperative Complications
  • Pain, Postoperative
  • Infant, Newborn
  • Humans
  • Female
  • Clonidine
  • Cesarean Section
  • Anesthesiology
  • Anesthesia, Obstetrical