Kaabachi Olfa, Zerelli Zied, Methamem Mehdi, Abdelaziz Ahmed Ben, Moncer Khaled, Toumi Mohsen
Department of Anesthesiology and Intensive Care Medicine, Hôpital Sahloul, Sousse, Tunisia.
Paediatr Anaesth. 2005 Jul;15(7):586-90. doi: 10.1111/j.1460-9592.2005.01497.x.
Coadministration of clonidine with local anesthetics is associated with improvement of the quality of peripheral nerve block and significant prolongation of postoperative analgesia. Better analgesia has been reported with clonidine in ilioinguinal nerve block compared with caudal use. The object of this study was to determine whether adding of 1 microg.kg(-1) clonidine to bupivacaine 0.25% in ilioinguinal-iliohypogastric nerve block prolongs postoperative analgesia in children.
Ninety-eight children ASA I-II aged between 1 and 12 years, scheduled for elective outpatient herniorrhaphy or orchidopexy were randomly allocated to receive an ilioinguinal-iliohypogastric nerve block either with 0.3 ml.kg(-1) bupivacaine 0.25% plus 1 microg.kg(-1) clonidine or only bupivacaine. Postoperative analgesic needs, time to the first analgesic supplementation and sedation score were assessed in hospital for 6 h postoperatively and at home by telephone call.
Demographic data were similar in both groups. There was no statistical difference in the rate of rescue analgesia between the two groups during the first six postoperative hours (20.4% group clonidine vs 30.6% group no clonidine) (P = 0.17). A slight decrease in systolic blood pressure during surgery was reported in the clonidine group. There was no difference in the scores of sedation between the two groups. At home, 10 patients in the clonidine group and nine patients in the nonclonidine group received analgesic medication. There was no difference between the two groups regarding the number of patients receiving analgesic rescue during the first 24 h (log rank = 0.39). Parental satisfaction was high in both groups.
Our study failed to demonstrate any advantage in addition of 1 microg.kg(-1) clonidine to 0.25% bupivacaine for ilioinguinal-iliohypogastric nerve block compared with bupivacaine 0.25% alone.
可乐定与局部麻醉药联合使用可改善外周神经阻滞质量，并显著延长术后镇痛时间。与骶管阻滞相比，可乐定用于髂腹股沟神经阻滞时镇痛效果更佳。本研究的目的是确定在儿童髂腹股沟 - 髂腹下神经阻滞中，于0.25%布比卡因中添加1μg·kg⁻¹可乐定是否能延长术后镇痛时间。
98例年龄在1至12岁、ASA分级为I - II级、计划行择期门诊疝气修补术或睾丸固定术的儿童，被随机分配接受髂腹股沟 - 髂腹下神经阻滞，一组接受0.3ml·kg⁻¹ 0.25%布比卡因加1μg·kg⁻¹可乐定，另一组仅接受布比卡因。术后在医院评估6小时内及术后通过电话在家中评估术后镇痛需求、首次补充镇痛药的时间和镇静评分。
两组的人口统计学数据相似。术后前六个小时内两组的补救性镇痛率无统计学差异（可乐定组为20.4%，无可乐定组为30.6%）（P = 0.17）。可乐定组报告手术期间收缩压略有下降。两组的镇静评分无差异。在家中，可乐定组有10例患者，非可乐定组有9例患者接受了镇痛药物治疗。两组在术后24小时内接受镇痛补救的患者数量无差异（对数秩检验 = 0.39）。两组家长的满意度都很高。
与单独使用0.25%布比卡因相比，我们的研究未能证明在髂腹股沟 - 髂腹下神经阻滞中于0.25%布比卡因中添加1μg·kg⁻¹可乐定有任何优势。
