Casati Andrea, Vinciguerra Federico, Cappelleri Gianluca, Aldegheri Giorgio, Fanelli Guido, Putzu Marta, Chelly Jacques E
*Department of Anesthesiology, University of Parma, Parma, Italy; †Department of Anesthesiology, Vita-Salute University of Milano, Milano, Italy; and ‡Department of Anesthesiology, University School of Medicine, Pittsburgh, Pennsylvania.
Anesth Analg. 2005 Mar;100(3):866-872. doi: 10.1213/01.ANE.0000143952.75985.8F.
We evaluated the effects of adding clonidine for continuous peripheral nerve infusions. Sixty patients undergoing total knee arthroplasty under combined single-injection sciatic block and continuous femoral infusion were randomly allocated to three groups: block induction with 0.75% ropivacaine followed by 0.2% ropivacaine (group control; n = 20); block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine (group cloni-bolus; n = 20), and block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine with 1 microg/mL clonidine (group cloni-infusion; n = 20). After surgery, continuous femoral infusion was provided with a patient-controlled infusion pump (basal infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min). The median (range) onset time of surgical block was 15 min (5-30 min) in group control, 10 min (5-35 min) in group cloni-bolus, and 10 min (5-30 min) in group cloni-infusion (P = 0.07). No differences were reported among groups in the degree of pain measured with the visual analog scale. The total consumption of local anesthetic solution after a 24-h infusion was 170 mL (144-220 mL) in group control, 169 mL (144-260 mL) in group cloni-bolus, and 164 mL (144-248 mL) in group cloni-infusion (P = 0.51); after the second day of infusion, total consumption was 168 mL (144-200 mL) in group control, 156 mL (144-288 mL) in group cloni-bolus, and 150 mL (144-210 mL) in group cloni-infusion (P = 0.48). Hemodynamic profiles and sedation were similar in the three groups. Motor function impairment after 48 h of infusion was observed in 27% of cloni-infusion patients but in only 6% of both the control and cloni-bolus groups (P = 0.05). We conclude that adding clonidine 1 microg/mL to local anesthetic for continuous femoral nerve block does not improve the quality of pain relief but has the potential for delaying recovery of motor function.
我们评估了添加可乐定用于连续周围神经输注的效果。60例接受坐骨神经单次注射联合股神经连续输注下行全膝关节置换术的患者被随机分为三组：用0.75%罗哌卡因诱导阻滞，随后用0.2%罗哌卡因（对照组；n = 20）；用0.75%罗哌卡因和1μg/kg可乐定诱导阻滞，随后用0.2%罗哌卡因（可乐定推注组；n = 20）；用0.75%罗哌卡因和1μg/kg可乐定诱导阻滞，随后用含1μg/mL可乐定的0.2%罗哌卡因（可乐定输注组；n = 20）。术后，使用患者自控输注泵进行股神经连续输注（基础输注速率，6 mL/h；追加剂量，2 mL；锁定时间，15分钟）。对照组手术阻滞的中位（范围）起效时间为15分钟（5 - 30分钟），可乐定推注组为10分钟（5 - 35分钟），可乐定输注组为10分钟（5 - 30分钟）（P = 0.07）。各组间采用视觉模拟量表测量所得的疼痛程度无差异。24小时输注后局部麻醉药溶液的总消耗量在对照组为每小时170 mL（144 - 220 mL），可乐定推注组为每小时每小时169 mL（144 - 260 mL），可乐定输注组为每小时164 mL（144 - 248 mL）（P = 0.51）；输注第二天后，对照组总消耗量为每小时168 mL（144 - 200 mL），可乐定推注组为每小时156 mL（144 - 288 mL），可乐定输注组为每小时150 mL（144 - 210 mL）（P = 0.48）。三组的血流动力学参数和镇静情况相似。输注48小时后，可乐定输注组27%的患者出现运动功能障碍，而对照组和可乐定推注组仅为6%（P = 0.05）。我们得出结论，在局部麻醉药中添加1μg/mL可乐定用于股神经连续阻滞并不能改善疼痛缓解质量，但有可能延迟运动功能恢复。
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