Effect of oral clonidine premedication on perioperative hemodynamics and postoperative analgesia in patients undergoing laparoscopic cholecystectomy: A prospective randomized double-blind placebo-controlled clinical trial

Abstract

Background: Laryngoscopy, endotracheal intubation, and creation of pneumoperitoneum during laparoscopic cholecystectomy cause sympathetic stimulation manifesting as hypertension, tachycardia, arrhythmia, and myocardial ischemia. Methods: We undertook this study to determine the effect of oral clonidine premedication on perioperative hemodynamics, postoperative pain, and sedation for patients undergoing laparoscopic cholecystectomy. In this double-blinded randomized controlled trial, 100 American Society of Anesthesiologists Grades I and II patients scheduled for laparoscopic cholecystectomy were randomized into 2 groups to receive 100 μg tablet clonidine in Group I and ranitidine 150 mg tablet in Group II (control group) 90 min before induction of general endotracheal anesthesia. Effect on hemodynamic parameters, duration of analgesia, requirement of rescue analgesic, and sedation score was assessed. Data were expressed as mean ± standard deviation or number (proportion). Unpaired t-test and Chi-square test were applied wherever indicated. P < 0.05 was considered statistically significant. Results: Patients in the clonidine group had lower systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate values as compared to control group at all measured time intervals (P < 0.05). The duration of analgesia was prolonged in the clonidine group (256.6 ± 34.97 min vs. 103.4 ± 10.94 min, P = 0.000). Total amount (88.50 ± 29.11 mg vs. 165.00 ± 30.31 mg, P = 0.000) and number of doses (1.18 ± 0.39 vs. 2.20 ± 0.40, P = 0.000) of rescue analgesic requirement in 1st 24 h postoperative period were also lesser in clonidine group. The sedation score was higher in clonidine group just after extubation (2.24 ± 0.43) as compared to the placebo group (1.92 ± 0.40, P = 0.000) at 1 h of postoperative period. Conclusion: Premedication with 100 μg clonidine provides stable hemodynamics against stress response triggered by the creation of pneumoperitoneum, laryngoscopy, and endotracheal intubation in patients undergoing laparoscopic cholecystectomy and also prolongs the duration of postoperative analgesia with reduced requirement of rescue analgesics without causing prolonged postoperative sedation.

Keywords

• analgesia
• clonidine
• hemodynamics
• laparoscopic cholecystectomy
• pneumoperitoneum