Eighty-nine patients with pelvic or acetabular fractures were randomized to receive oral clonidine 200 mcg 75–90 min pre-anesthesia (n=45) or placebo (n=44). The primary outcome of interest was blood loss (intra- and postoperative, including hidden loss). Secondary outcomes of interest included postoperative pain (VAS), surgeon-rated visual field quality, hemoglobin (preop, postoperative day 1 and day 3), proportion requiring transfusion, and duration of surgery. Outcomes were assessed up to postoperative day 3. Overall, the results of the study revealed lower intraoperative blood loss, less pain, better surgical field ratings, higher day-3 hemoglobin, and fewer transfusions with clonidine versus placebo, without a difference in postoperative drain output or operative time. These findings suggest preoperative clonidine may be a simple adjunct to reduce bleeding and analgesic burden in pelvic/acetabular trauma surgery.