One hundred twenty-nine patients undergoing surgery for degenerative spine disease were randomized to intraoperative clonidine 3 μg/kg (n=65) or placebo (n=64). The primary outcome was cumulative IV morphine-equivalent consumption in the first 3 hours post-PACU arrival. Secondary outcomes included 6-hour opioid use; pain at rest and with cough at 0–120 min; PONV and Ramsay sedation at 0, 60, and 120 min; and time to PACU discharge, hospital length of stay, and daily opioid use at 1 month. Overall, the results of the study revealed no reductions with clonidine in 3-hour (p=0.58) or 6-hour (p=0.76) opioid use, no between-group differences in pain scores, and more hypotension requiring treatment with clonidine (25 vs 13; p=0.04). In short, a single intraoperative clonidine dose conferred no analgesic benefit and increased hypotension risk in this setting.