Postoperative morphine clonidine analgesia in high-risk patients

Intramuscular injections of the opiates in some cases cannot provide effective analgesia in patients after traumatic abdominal surgery. The purpose of our research was clinical evaluation of the efficiency of postoperative morphine clonidine epidural analgesia in high-risk patients (ASA III-IV). Epidural analgesia – morphine hydrochloride 4 mg in combination with clonidine 0.05 mg – was applied in 80 patients aged from 44 to 77 during 3 days of the postoperative period, patients with unstable hemodynamics inclusively. The epidural space was identified at the level Th_5–6 with the following insertion of the catheter by 3–4 cm into the epidural space. Sufficient analgetic effect was observed in 20–30 min after administration of morphine and clonidine and lasted for 10–12 hours. Hemodynamic state remained stable provided sufficient intravenous 'preload' infusion had been performed before the procedure, while the effect of arteriodilatation and hemodilution was observed – CVP went down by 15% (P > 0.01), hemoglobin and hematocrit dropping by 7–9% (P > 0.01). At the same time slower heart rate and breath rate were observed. Analgetic effect was scored individually in conformity with the rating scale coming from 0 points (the best effect) to 10 points (the worst effect). The average score before the injection was at 7.2 ± 2.1, with the following decrease to 3.1 ± 1.2 one hour after the injection. It is necessary to admit that scores depended on an individual patient.

Advantages of the postoperative morphine clonidine epidural analgesia were that sufficient pain relief was not accompanied by a long lasting sedation effect, which enabled patients to remain active enough to move in bed, breath deeply, and secure effective cough.

Therefore, postoperative morphine clonidine epidural analgesia may be regarded as an alternative method of analgesia in high-risk patients after abdominal surgery.