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The Impact of Neuraxial Clonidine on Postoperative Analgesia in Women Having Cesarean Section – A Systematic Review and Meta-Analysis
Abstract Number: SAT-35
Abstract Type: Meta Analysis/Review of the Literature
Introduction: Neuraxial clonidine improves postoperative analgesia in the general surgical population. The efficacy and safety of neuraxial clonidine as a postoperative analgesic adjunct in the cesarean 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 cesarean section under neuraxial anesthesia.
Methods: We included randomized controlled trials comparing the analgesic efficacy of the perioperative administration of neuraxial clonidine alone or in combination with a local anesthetic and/or opioid in women having cesarean section under neuraxial anesthesia when compared with placebo. Pubmed, the Cochrane Central Register of Controlled Trials and EMBASE were searched. Our primary outcomes were intravenous opioid consumption in mg morphine equivalents at 24h and the time to first analgesic request. Secondary outcomes included the need for intraoperative analgesic supplementation, incidence of maternal intraoperative and postoperative adverse effects and neonatal umbilical artery pH and Apgar scores at 1 and 5 minutes. Data from dichotomous outcomes were summarized using odds ratio (OR) and 95% confidence intervals (CI). Continuous outcomes were summarized as mean difference (MD) and 95% CI. A random effects statistical model was used as the default for the analysis.
Results: Seventeen studies were included in the meta- analysis. Neuraxial clonidine reduced 24 h morphine consumption (MD: -7.2 mg; 95% CI: -11.4, -3.0, 7 studies) (Figure A) and prolonged time to first analgesic request (MD: 141 minutes; 95% CI: 106, 175 minutes, 15 studies) (Figure B) when compared with the control group. Neuraxial clonidine increased intraoperative hypotension (OR: 2.567; 95% CI: 1.187, 5.551), 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 and Apgar scores.
Conclusion: This review demonstrates that neuraxial clonidine enhances postoperative analgesia in women having cesarean section with neuraxial anesthesia but this has to be balanced against the increased maternal adverse effects.