In this study, we evaluated the effect of intrathecal and oral
clonidine as supplements to
spinal anesthesia with
lidocaine in patients at risk of postoperative alcohol withdrawal syndrome (AWS). We hypothesized that
clonidine would have a prophylactic effect on postoperative AWS. Forty-five alcohol-dependent patients (daily
ethanol intake >60 g) scheduled for transurethral resection of the prostate were double-blindly randomized into three groups. All patients received hyperbaric
lidocaine 100 mg intrathecally. The
diazepam group (DiazG) was premedicated with
diazepam 10 mg orally; the intrathecal
clonidine group (Clon(i/t)G) received a placebo (saline)
tablet and
clonidine 150 microg intrathecally; and the oral
clonidine group (Clon(p/o)G) received
clonidine 150 microg orally. For patients diagnosed with AWS, the Clinical Institute Withdrawal Assessment for Alcohol, revised scale, was used. Twelve patients in the DiazG had symptoms of AWS, compared with two in the Clon(i/t)G and one in the Clon(p/o)G. The median Clinical Institute Withdrawal Assessment for Alcohol, revised scale, score was 12 in the DiazG versus 1 in the
clonidine-treated groups. Two patients in the DiazG had severe
delirium. Patients receiving oral
clonidine had a slightly decreased mean arterial blood pressure 6-12 h after
spinal anesthesia (P < 0.05); patients in the DiazG had a hyperdynamic circulatory reaction 24-72 h after surgery. In conclusion, preoperative
clonidine 150 microg, intrathecally or orally, prevented significant postoperative AWS in
ethanol-dependent patients.
IMPLICATIONS: In this randomized, double-blinded study,
clonidine 150 microg both intrathecally and orally prevented postoperative alcohol-
withdrawal symptoms in alcohol-dependent men. The effect was superior to that with a single dose of
diazepam 10 mg orally.