Preoperative clonidine use in trans-sphenoidal pituitary adenoma surgeries - a randomized controlled trial

Br J Neurosurg. 2017 Feb;31(1):2-4. doi: 10.1080/02688697.2016.1220501. Epub 2016 Aug 18.

Abstract

Background: Pituitary masses are common lesions accounting for about 15-20% of all brain tumours. Oozing blood is an annoyance in microscopic sublabial trans-sphenoidal approach for these masses. There have been many ways of reducing the ooze, having their own pros and cons.

Objective: To find out the efficacy and safety of clonidine in reducing blood loss in pituitary adenoma surgery through a randomized masked trial.

Methods: It was a prospective randomized controlled trial done. Total 50 patients of pituitary adenomas were randomized into two groups. Group A (25 patients) was given 200 μg clonidine orally, while Group B (25 patients) was given placebo. Surgeon, anaesthesiologist and patient were blinded for the trial. Sublabial trans-septal trans-sphenoidal approach to sella and excision of mass was performed in each patient. Patients were studied for pre-, intra- and post-operative blood pressure and heart rate, pre- and post-operative imaging findings, intra-operative blood loss, bleeding grading by surgeon, surgeon's satisfaction about condition of specific part and quality of surgical field, operative time and extent of resection.

Results: Blood loss during the surgery, operative time and bleeding grading by the surgeon were found significantly less in the clonidine group, while quality of surgical field, condition of the specific part and extent of resection were found significantly better in the clonidine group (p value <.05). There was no untoward adverse effect of the drug in the test group.

Conclusion: Clonidine is a safe and effective drug to reduce bleeding in trans-sphenoidal microscopic pituitary adenoma surgeries.

Keywords: Blood loss; clonidine; pituitary; sublabial trans-sphenoidal.

MeSH terms

  • Adenoma / surgery*
  • Adrenergic alpha-Agonists / adverse effects
  • Adrenergic alpha-Agonists / therapeutic use*
  • Adult
  • Blood Loss, Surgical / prevention & control*
  • Clonidine / adverse effects
  • Clonidine / therapeutic use*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Operative Time
  • Pituitary Neoplasms / surgery*
  • Preoperative Care
  • Prospective Studies
  • Septum of Brain / surgery
  • Sphenoid Bone / surgery*
  • Young Adult

Substances

  • Adrenergic alpha-Agonists
  • Clonidine