De Negri P, Ivani G, Visconti C, De Vivo P, Lonnqvist P A
Department of Anesthesia and Intensive Care, IRCCS H "Casa Sollievo della Sofferenza" S. Giovanni Rotondo (FG), Italy.
Anesth Analg. 2001 Jul;93(1):71-6. doi: 10.1097/00000539-200107000-00016.
Epidurally administered clonidine enhances the quality and duration of postoperative analgesia when it is used as an adjunct to local anesthetics in children. We investigated the dose-response relationship for epidural clonidine when added to a continuous postoperative epidural infusion of ropivacaine. By use of an observer-blinded design, 55 pediatric patients (1-4 yr old) were randomly given a postoperative epidural infusion of plain ropivacaine 0.1% 0.2 mg. kg(-1). h(-1) (Group R), ropivacaine 0.08% 0.16 mg. kg(-1). h(-1) plus clonidine 0.04 microg. kg(-1). h(-1) (Group RC1), ropivacaine 0.08% 0.16 mg. kg(-1). h(-1) plus clonidine 0.08 microg. kg(-1). h(-1) (Group RC2), or ropivacaine 0.08% 0.16 mg. kg(-1). h(-1) plus clonidine 0.12 microg. kg(-1). h(-1) (Group RC3). A clear dose-response relationship could be identified for a continuous infusion of epidural clonidine, with clonidine dosages in the 0.08-0.12 microg. kg(-1). h(-1) range providing improved postoperative analgesia (reduced Children's Hospital of Eastern Ontario pain score, increased time to first supplemental analgesic demand, and a reduced total number of doses of supplemental analgesics during the first 48 h after surgery). Analgesia was improved without any signs of increased sedation or other side effects. The adjunct use of epidural clonidine in the dosage range of 0.08-0.12 microg. kg(-1). h(-1) appears effective and safe for use in children.
The addition of clonidine (0.08-0.12 microg.kg(-1).h(-1))to a continuous epidural infusion of ropivacaine was found to improve postoperative pain relief in children. No clinically significant signs of sedation or other side effects were observed.
硬膜外给予可乐定作为局部麻醉药的辅助用药时，可提高儿童术后镇痛的质量和持续时间。我们研究了硬膜外可乐定加入罗哌卡因术后持续硬膜外输注时的剂量 - 反应关系。采用观察者盲法设计，55例儿科患者（1 - 4岁）被随机给予术后硬膜外输注0.1%罗哌卡因0.2 mg·kg⁻¹·h⁻¹（R组）、0.08%罗哌卡因0.16 mg·kg⁻¹·h⁻¹加可乐定0.04 μg·kg⁻¹·h⁻¹（RC1组）、0.08%罗哌卡因0.16 mg·kg⁻¹·h⁻¹加可乐定0.08 μg·kg⁻¹·h⁻¹（RC2组）或0.08%罗哌卡因0.16 mg·kg⁻¹·h⁻¹加可乐定0.12 μg·kg⁻¹·h⁻¹（RC3组）。对于持续硬膜外输注可乐定，可确定明显的剂量 - 反应关系，可乐定剂量在0.08 - 0.12 μg·kg⁻¹·h⁻¹范围内可改善术后镇痛（降低安大略东部儿童医院疼痛评分、延长首次追加镇痛药物需求时间以及减少术后48小时内追加镇痛药物的总剂量）。镇痛效果改善且无镇静增加或其他副作用的迹象。硬膜外可乐定在0.08 - 0.12 μg·kg⁻¹·h⁻¹剂量范围内辅助使用对儿童似乎有效且安全。
发现将可乐定（0.08 - 0.12 μg·kg⁻¹·h⁻¹）加入罗哌卡因持续硬膜外输注可改善儿童术后疼痛缓解。未观察到镇静或其他副作用的临床显著迹象。
