Eighty-eight patients with pelvic or acetabular fractures were randomized to receive either 200 mcg of oral clonidine (n=44) or a placebo (n=44) 75 to 90 minutes before anesthesia. The primary outcome of interest was blood loss volume and the need for postoperative blood transfusion. Secondary outcomes included postoperative hemoglobin levels, postoperative pain, and the quality of the surgical visual field. Outcomes were assessed at baseline, one day, and three days postoperatively. Overall, the results revealed that postoperative hemoglobin levels dropped in both groups but were significantly higher in the clonidine group by day three. Additionally, fewer patients in the clonidine group required blood transfusions. Preoperative clonidine also significantly reduced postoperative pain and improved the surgeon's visual field quality. These findings suggest that oral clonidine can effectively minimize blood loss, improve surgical conditions, and reduce the need for postoperative transfusions in pelvic and acetabular fracture surgeries.