Comparative evaluation of clonidine and metoprolol for perioperative hemodynamic stability, blood loss control, and postoperative recovery in patients undergoing elective surgery: a prospective randomized controlled study

Abstract

Background & objective: Maintaining hemodynamic stability and minimizing blood loss are critical goals in perioperative care. Clonidine, an α2-adrenergic agonist, and metoprolol, a selective β1-blocker, are frequently used to modulate cardiovascular responses during surgery. However, their comparative efficacy in reducing intraoperative blood loss and supporting postoperative recovery remains a subject of clinical interest. This study compared the efficacy of the both to facilitate the choice.

Methodology: This prospective, randomized controlled trial included 60 ASA I–II patients aged 18–60 years undergoing elective surgery under general anesthesia. Participants were randomized to receive either oral clonidine (0.15 mg, Group-C, n = 30) or metoprolol (50 mg, Group-M, n = 30) two hours before surgery. Intraoperative hemodynamic parameters, estimated blood loss, surgical field quality, and postoperative outcomes including pain score, nausea incidence, recovery time, and hospital stay were recorded and statistically analyzed.

Results: Both groups maintained stable intraoperative heart rate, blood pressure, and oxygen saturation (P > 0.05). Clonidine significantly reduced intraoperative blood loss compared to metoprolol (137 ± 14.71 mL vs. 151 ± 9.94 mL, P = 0.0002) and achieved better surgical field visibility (Good field: 70% vs. 56.7%, P = 0.041). Postoperative outcomes, including pain scores, recovery time, and hospital stay, were comparable across groups (P > 0.05).

Conclusion: Clonidine and metoprolol are both effective for intraoperative hemodynamic control and safe postoperative recovery. However, clonidine demonstrates a distinct advantage in minimizing blood loss and improving surgical field quality. These findings support its preferential use in procedures where blood conservation is crucial. Larger multicentric studies are recommended to guide patient-specific drug selection in perioperative management.

Keywords: Blood loss; Clonidine; Elective surgery; Hemodynamic stability; Hospital stay; Metoprolol; Pain scores; Postoperative recovery

Citation: Sereen V.a B, Natarajan S, Arunkumar B, Shanmugasundaram S, Choudhary AK, Periasamy P. Comparative evaluation of clonidine and metoprolol for perioperative hemodynamic stability, blood loss control, and postoperative recovery in patients undergoing elective surgery: a prospective randomized controlled study. Anaesth. pain intensive care 2026;30(2):189-199. DOI: 10.35975/apic.v30i2.3126

Received: May 13, 2025; Revised: May 17, 2025; Accepted: June 07, 2025