{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:30:27Z","timestamp":1786728627108,"version":"build-2736575974"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Introduction:<\/jats:title>\n Monitored anesthesia care (MAC) combines local anesthesia with sedoanalgesia to maintain patient comfort and hemodynamic stability. This study aimed to compare the analgesic efficacy, sedation quality, and hemodynamic changes between clonidine and midazolam\u2013fentanyl combinations during varicose vein surgery and to assess the effect of catechol-O-methyltransferase (COMT) gene polymorphism (rs4680) on postoperative pain modulation.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n In this prospective, randomized controlled trial, 50 American Society of Anesthesiologists I\u2013II patients were equally divided into two groups. Group I (clonidine) received 2 \u03bcg\/kg bolus followed by 0.2 \u03bcg\/kg\/h infusion, while Group II (midazolam\u2013fentanyl) received 0.06 mg\/kg midazolam and 1 \u03bcg\/kg fentanyl followed by 0.2 mL\/kg\/h infusion. Hemodynamic variables, pain scores (Visual Analog Scale [VAS]), sedation (Ramsay and Observer\u2019s Assessment of Alertness\/Sedation), and recovery (Aldrete) were assessed. The COMT rs4680 polymorphism was genotyped using polymerase chain reaction\u2013restriction fragment length polymorphism.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Baseline characteristics were comparable (\n P<\/jats:italic>\n > 0.05). Mean heart rate (HR), systolic, diastolic, and mean arterial pressures (MAPs) were significantly lower in the clonidine group at 10\u201360 min intraoperatively (e.g. HR: 70.04 \u00b1 3.77 vs. 78.60 \u00b1 2.97 beats\/min;\n P<\/jats:italic>\n < 0.001; MAP: 79.88 \u00b1 7.48 vs. 91.29 \u00b1 4.88 mmHg;\n P<\/jats:italic>\n < 0.001). Postoperative VAS scores were consistently lower in the clonidine group at 6 h (0.44 \u00b1 0.87 vs. 2.84 \u00b1 1.43;\n P<\/jats:italic>\n < 0.001), 12 h (0.00 \u00b1 0.00 vs. 1.60 \u00b1 1.26;\n P<\/jats:italic>\n < 0.001), and 18 h (0.00 \u00b1 0.00 vs. 0.84 \u00b1 0.90;\n P<\/jats:italic>\n < 0.001). Rescue analgesia was required in 32% versus 56% of patients, respectively (\n P<\/jats:italic>\n = 0.114). Respiratory distress occurred only in the midazolam\u2013fentanyl group (16%;\n P<\/jats:italic>\n = 0.037). COMT genotypes (CT = 54%, TT = 46%) showed no significant association with pain intensity (\n P<\/jats:italic>\n > 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Clonidine-based MAC provided better intraoperative hemodynamic stability, prolonged analgesia, and reduced postoperative pain compared with midazolam\u2013fentanyl, with minimal respiratory complications. The COMT rs4680 polymorphism did not significantly influence pain perception, highlighting the multifactorial nature of postoperative analgesic response.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/aam.aam_677_25","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T03:00:16Z","timestamp":1769482816000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Clonidine Provides Superior Hemodynamic Stability and Analgesia over Midazolam-fentanyl under Monitored Anesthesia Care: Role of Catechol-O-methyltransferase Polymorphism"],"prefix":"10.4103","author":[{"given":"Manish","family":"Kumar","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Critical Care, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anshu","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajni","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitu","family":"Nigam","sequence":"additional","affiliation":[{"name":"Centre for Advance Research, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,27]]},"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_677_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:29:33Z","timestamp":1786724973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_677_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":0,"URL":"https:\/\/doi.org\/10.4103\/aam.aam_677_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]},"assertion":[{"value":"2025-10-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}