Akbas Mert, Akbas Halide, Yegin Arif, Sahin Nursel, Titiz Tulin Aydogdu
Department of Anaesthesiology, Akdeniz University Medical Faculty, Antalya, Turkey.
Paediatr Anaesth. 2005 Jul;15(7):580-5. doi: 10.1111/j.1460-9592.2005.01506.x.
The purpose of this study was to compare the analgesic quality and duration of ropivacaine 0.2% with the addition of clonidine (1 microg.kg(-1)) with that of ropivacaine 0.2% and the addition of ketamine (0.5 mg.kg(-1)) to that of ropivacaine 0.2% and also compare the postoperative cortisol, insulin and glucose concentrations, sampled after induction and 1 h later following caudal administration in children.
According to the randomization, patients in the ropivacaine group (R; n = 25) received ropivacaine 0.2%, 0.75 ml.kg(-1); those in the clonidine group (RC; n = 25) received ropivacaine 0.2% 0.75 ml.kg(-1) plus clonidine 1 microg.kg(-1) and those in the ketamine/ropivacaine group (RK; n = 25) ropivacaine 0.2% 0.75 ml.kg(-1) plus ketamine 0.5 mg.kg(-1) (10 mg.ml(-1) concentration). Drugs were diluted in 0.9% saline (0.75 ml.kg(-1)) and prepared by a staff anesthesiologist not otherwise involved in the study. In all groups, the duration of analgesia, analgesic requirements, sedation and insulin, glucose, cortisol concentrations were recorded and statistically compared.
There were no significant differences among the three study groups with respect to age, weight or duration of surgery. Caudal administration of clonidine 1 microg.kg(-1) or ketamine 0.5 mg.kg(-1) induced a longer duration of analgesia (P < 0.05) compared with ropivacaine alone. Insulin levels were increased and cortisol reduced in all groups. Glucose concentration was increased in all groups and statistically significant (P < 0.05).
Addition of ketamine and clonidine to ropivacaine 0.2% 0.75 ml.kg(-1), when administered caudally in children, prolongs the duration of postoperative analgesia. The need for subsequent postoperative analgesic is also reduced. Caudal analgesia attenuates or allows partial changes to postoperative cortisol, insulin or blood glucose responses to surgery.
本研究旨在比较添加可乐定（1微克·千克⁻¹）的0.2%罗哌卡因与0.2%罗哌卡因本身以及添加氯胺酮（0.5毫克·千克⁻¹）的0.2%罗哌卡因的镇痛质量和持续时间，并比较小儿骶管给药诱导后及1小时后采集的术后皮质醇、胰岛素和葡萄糖浓度。
根据随机分组，罗哌卡因组（R组；n = 25）患者接受0.2%罗哌卡因，0.75毫升·千克⁻¹；可乐定组（RC组；n = 25）患者接受0.2%罗哌卡因0.75毫升·千克⁻¹加可乐定1微克·千克⁻¹；氯胺酮/罗哌卡因组（RK组；n = 25）患者接受0.2%罗哌卡因0.75毫升·千克⁻¹加氯胺酮0.5毫克·千克⁻¹（浓度为10毫克·毫升⁻¹）。药物用0.9%生理盐水（0.75毫升·千克⁻¹）稀释，由未参与本研究的麻醉科工作人员配制。记录所有组的镇痛持续时间、镇痛需求、镇静情况以及胰岛素、葡萄糖、皮质醇浓度，并进行统计学比较。
三个研究组在年龄、体重或手术持续时间方面无显著差异。与单独使用罗哌卡因相比，骶管注射1微克·千克⁻¹可乐定或0.5毫克·千克⁻¹氯胺酮可延长镇痛持续时间（P < 0.05）。所有组的胰岛素水平均升高，皮质醇水平降低。所有组的葡萄糖浓度均升高，且具有统计学意义（P < 0.05）。
小儿骶管注射时，在0.2%罗哌卡因0.75毫升·千克⁻¹中添加氯胺酮和可乐定可延长术后镇痛持续时间。后续术后镇痛的需求也会减少。骶管镇痛可减轻或使术后皮质醇、胰岛素或血糖对手术的反应发生部分改变。
