The Effect of Preoperative Oral Clonidine on Shoulder Pain in Laparoscopic Cholecystectomy with General Anesthesia

Laparoscopic cholecystectomy is now the gold standard for the treatment of gallbladder disease. The study evaluated the clinical preoperative effects of oral administration of clonidine on shoulder pain after surgery in patients undergoing laparoscopic cholecystectomy with general anesthesia.

64 patients, scheduled for elective laparoscopic cholecystectomy, were recruited for this prospective randomized double-blind comparative study. They were randomly allotted to either placebo or clonidine group. Patients of the placebo group (n = 32) were premedicated with placebo, while those in the clonidine group (n = 32) were premedicated with oral clonidine 150 micrograms prior to anesthesia. The premedication was given 90 minutes before the anticipated time of induction of anesthesia. Postoperative shoulder pain was recorded based on visual analog scale (VAS), and cumulative analgesic requirement was reported in 24 hours.

The postoperative VAS scores of shoulder pain were significantly less in clonidine group compared with placebo group at recovery period (P = 0.03). VAS scores were lower in clonidine group compared with the placebo group at 6, 12, and 24 hours postoperatively, but the differences were not significant (P > 0.05). Analgesic consumption was significantly less in clonidine group during 24 hours postoperatively (P = 0.02). Clonidine was not superior to placebo for attenuation of the hemodynamic responses to laryngoscopy and laparoscopy, but it increased the incidence of preoperative bradycardia (P = 0.02).

 A single oral dose of 150 micrograms clonidine, 90 minutes before induction of anesthesia for laparoscopic cholecystectomy, significantly reduces postoperative shoulder pain only at recovery period.