Dobrydnjov I, Axelsson K, Berggren L, Samarütel J, Holmström B
Departments of Anesthesiology and Intensive Care, Orebro University Hospital, Orebro, Sweden.
Anesth Analg. 2004 Mar;98(3):738-44, table of contents. doi: 10.1213/01.ane.0000099719.97261.da.
In this study, we evaluated the effect of intrathecal and oral clonidine as supplements to spinal anesthesia with lidocaine in patients at risk of postoperative alcohol withdrawal syndrome (AWS). We hypothesized that clonidine would have a prophylactic effect on postoperative AWS. Forty-five alcohol-dependent patients (daily ethanol intake >60 g) scheduled for transurethral resection of the prostate were double-blindly randomized into three groups. All patients received hyperbaric lidocaine 100 mg intrathecally. The diazepam group (DiazG) was premedicated with diazepam 10 mg orally; the intrathecal clonidine group (Clon(i/t)G) received a placebo (saline) tablet and clonidine 150 microg intrathecally; and the oral clonidine group (Clon(p/o)G) received clonidine 150 microg orally. For patients diagnosed with AWS, the Clinical Institute Withdrawal Assessment for Alcohol, revised scale, was used. Twelve patients in the DiazG had symptoms of AWS, compared with two in the Clon(i/t)G and one in the Clon(p/o)G. The median Clinical Institute Withdrawal Assessment for Alcohol, revised scale, score was 12 in the DiazG versus 1 in the clonidine-treated groups. Two patients in the DiazG had severe delirium. Patients receiving oral clonidine had a slightly decreased mean arterial blood pressure 6-12 h after spinal anesthesia (P < 0.05); patients in the DiazG had a hyperdynamic circulatory reaction 24-72 h after surgery. In conclusion, preoperative clonidine 150 microg, intrathecally or orally, prevented significant postoperative AWS in ethanol-dependent patients.
In this randomized, double-blinded study, clonidine 150 microg both intrathecally and orally prevented postoperative alcohol-withdrawal symptoms in alcohol-dependent men. The effect was superior to that with a single dose of diazepam 10 mg orally.
在本研究中，我们评估了鞘内注射和口服可乐定作为利多卡因脊髓麻醉辅助用药对有术后酒精戒断综合征（AWS）风险患者的影响。我们假设可乐定对术后AWS有预防作用。45例计划行经尿道前列腺切除术的酒精依赖患者（每日乙醇摄入量>60 g）被双盲随机分为三组。所有患者均鞘内注射100 mg高压利多卡因。地西泮组（DiazG）术前口服10 mg地西泮进行预处理；鞘内可乐定组（Clon(i/t)G）接受安慰剂（生理盐水）片剂并鞘内注射150 μg可乐定；口服可乐定组（Clon(p/o)G）口服150 μg可乐定。对于诊断为AWS的患者，使用修订版酒精临床研究所戒断评估量表。DiazG组有12例患者出现AWS症状，而Clon(i/t)G组有2例，Clon(p/o)G组有1例。DiazG组酒精临床研究所戒断评估量表修订版评分中位数为12，而可乐定治疗组为1。DiazG组有2例患者出现严重谵妄。口服可乐定的患者在脊髓麻醉后6 - 12小时平均动脉血压略有下降（P < 0.05）；DiazG组患者在术后24 - 72小时出现高动力循环反应。总之，术前鞘内或口服150 μg可乐定可预防酒精依赖患者术后出现明显的AWS。
在这项随机双盲研究中，鞘内和口服150 μg可乐定均可预防酒精依赖男性患者术后的酒精戒断症状。其效果优于口服单剂量10 mg地西泮。
