Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Department of Orthopedics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
Br J Clin Pharmacol. 2024 Dec;90(12):3003-3009. doi: 10.1111/bcp.15948. Epub 2023 Nov 24.
Pain can create physical and psychosocial discomfort. Pain management of patients with opioid misuse history can be challenging, in part due to their tolerance to opioids. Clonidine is an alpha-2 agonist that has been used for the reduction of anxiety and pain. The aim of this study was to investigate the effect of oral clonidine on pain outcomes in patients with a history of opioid use disorder presenting with orthopaedic fractures in the emergency room.
In this blinded clinical trial in the emergency department, 70 opioid-dependent patients with orthopaedic fractures were divided into a control group of 35 and an intervention group of 35 subjects. Initially, 0.2 mg of oral clonidine was given to the intervention group and the control group received placebo tablets. Pain levels were recorded based on the Numerical Rating Scale rating before intervention, at 30 min, 1 h after intervention and at disposition from the emergency room (3-6 h after intervention). The total morphine requirement was also recorded.
The pain score of the clonidine group was significantly lower than that of the control group at 1 h and at disposition time. The amount of morphine required was significantly reduced in the clonidine group (P < 0.05). Oral clonidine had no significant effect on pulse rate. Oral clonidine was more effective for pain reduction in lower limb injuries.
Oral clonidine significantly reduced pain and the need for morphine in opioid-dependent patients with orthopaedic fractures.
疼痛会造成身体和心理不适。有阿片类药物滥用史的患者的疼痛管理具有挑战性，部分原因是他们对阿片类药物的耐受。可乐定是一种α-2 激动剂，已被用于减轻焦虑和疼痛。本研究旨在探讨口服可乐定对骨科骨折急诊就诊的阿片类药物使用障碍患者疼痛结局的影响。
在这项急诊科的双盲临床试验中，将 70 名有骨科骨折的阿片类药物依赖患者分为对照组（n=35）和干预组（n=35）。干预组首先给予 0.2mg 口服可乐定，对照组给予安慰剂片。在干预前、30 分钟、干预后 1 小时以及从急诊室出院时（干预后 3-6 小时）根据数字评分量表评分记录疼痛水平。还记录了总吗啡需求量。
可乐定组的疼痛评分在 1 小时和出院时明显低于对照组。可乐定组的吗啡需求量明显减少（P<0.05）。可乐定对脉搏率没有显著影响。可乐定对下肢损伤的止痛效果更显著。
口服可乐定可显著减轻骨科骨折的阿片类药物依赖患者的疼痛和吗啡需求。
