Summary of findings for the main comparison. Clonidine compared to placebo or no treatment for postoperative analgesia in children.
| Clonidine compared to placebo or no treatment for postoperative analgesia in children | ||||||
| Patient or population: patients with postoperative pain Settings: paediatric surgery Intervention: clonidine Comparison: placebo or no treatment | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo/no treatment | Clonidine | |||||
| Number requiring additional analgesia at any time postoperatively ‐ low dose clonidine | 867 per 1000 | 867 per 1000 (676 to 1000) | RR 1 (0.78 to 1.28) | 45 (1 study) | ⊕⊕⊝⊝ low1,2 | |
| Number requiring additional analgesia at any time postoperatively ‐ high dose clonidine | 558 per 1000 | 134 per 1000 (61 to 285) | RR 0.24 (0.11 to 0.51) | 205 (3 studies) | ⊕⊕⊕⊝ moderate3,4 | |
| Number requiring additional analgesia at any time postoperatively ‐ high dose clonidine, studies with lower risk of bias | 700 per 1000 | 168 per 1000 (63 to 483) | RR 0.24 (0.09 to 0.69) | 160 (2 studies) | ⊕⊕⊕⊝ moderate1 | |
| Postoperative pain score ‐ low dose clonidine | The mean postoperative pain score ‐ low dose clonidine in the intervention groups was 0.23 standard deviations higher (0.4 lower to 0.85 higher) | 45 (1 study) | ⊕⊕⊝⊝ low1,2 | SMD 0.23 (‐0.4 to 0.85) | ||
| Postoperative pain score ‐ high dose clonidine | The mean postoperative pain score ‐ high dose clonidine in the intervention groups was 1.11 standard deviations lower (1.46 to 0.75 lower) | 145 (2 studies) | ⊕⊕⊕⊝ moderate1 | SMD ‐1.11 (‐1.46 to ‐0.75) | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Missing information on methods of randomization and allocation concealment. 2 Single, small study. 3 Missing information on methods of randomization and allocation concealment; no information at all for Georgiou 1999 study.
4 GRADE Quality of evidence is weighted towards 'Moderate' by the two studies judged to be at lower risk of bias.