0077 Clonidine premedication for postoperative analgesia in children: a meta-analysis Paul Lambert , Nicholas Knight , Philippa Middleton , Allan

Cyna 1 Department of Anaesthetics, Flinders Medical Centre, Bedford Park, South Australia, Australia, 3 2 Department of Anaesthetics, Royal Adelaide Hospital, Adelaide, South Australia, Australia, Australian Research Centre for Health of Women and Babies (ARCH), Robinson Institute, University of Adelaide, 4 Adelaide, South Australia, Australia, Department of Women's Anaesthesia, Women's and Children's Hospital, North Adelaide, South Australia, Australia Introduction: Postoperative pain is a significant problem in paediatric surgery. Inadequate analgesia increases patient distress in the short term and may have long-term adverse effects. The alpha-2 adrenergic agonist, clonidine, has been used as a premedication for anxiolysis, sedation, analgesia, and reduction of heart rate and blood pressure. However, its use can result in excessive sedation, 1 hypotension, and bradycardia . The overall benefits of clonidine as a premedication over other commonly 2 3 used drugs, such as midazolam, have in recent years been the subject of review and meta-analysis . This systematic review aims to evaluate the postoperative analgesia effects of clonidine premedication when compared to any other treatment, placebo or usual care. Methods: This study was conducted according to Cochrane methodology. We searched for randomized or quasi-randomized controlled trials of children < 18 years presenting for general anaesthesia. We included any study where clonidine premedication was administered and compared with any other intervention or no treatment. Primary outcomes were: the requirement for supplementary analgesia, either in the post-anaesthesia care unit (PACU) or subsequently, and excessive sedation requiring intervention. Secondary outcome measures included: pain scores, opioid use, haemodynamic outcomes, and time until discharge from PACU and the hospital. Meta-analysis was performed using a random effects, Mantel-Haenszel model. Results: Database search found 179 studies of which 39 papers were retrieved in full. Ten studies investigating 729 children were subsequently found suitable for inclusion. Four compared clonidine with placebo or no treatment, five compared clonidine with midazolam and one compared clonidine premedication with fentanyl. Clonidine was associated with a non-significant reduction in the incidence of postoperative analgesia use in the three trials with data, suitable for meta-analysis, investigating this comparison - RR 0.28 [95%CI 0.05,1.45]. There was a significant reduction in the one study comparing clonidine with midazolam presenting dichotomous data, RR 0.25 [95% CI 0.12, 0.53]. There was no difference in incidence of postoperative analgesia use in the one study comparing clonidine with fentanyl, RR 0.71, [95%CI 0.18, 2.89]. Conclusion: Preliminary findings suggest that clonidine decreased the incidence of postoperative analgesia use when compared with midazolam and possibly placebo or no treatment. However there was no difference in postoperative analgesia use when clonidine was compared with fentanyl. References: 1. Nishina K, et al. (1999) Paediatr. Anaesth. 9:187-202. 2. Bergendahl, H., et al. (2006) Acta Anaesthesiol. Scand. 50: 135-143. 3. Dahmani, S., et al. (2010) Acta. Anaesthesiol. Scand. 54: 397-402.
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