Boussofara Mehdi, Carlès Michel, Raucoules-Aimé Marc, Sellam Mohamed Riadh, Horn Jean-Louis
Département d'Anesthésie-Réanimation, Hôpital Aziza Othmana, Tunis, Tunisia.
Reg Anesth Pain Med. 2006 Nov-Dec;31(6):501-5. doi: 10.1016/j.rapm.2006.05.013.
Previous clinical and experimental studies have shown that a midazolam-clonidine mixture has a synergistic antinociceptive effect. This study evaluated the postoperative analgesic effect of adding midazolam to an intrathecal bupivacaine-clonidine mixture.
One hundred ten patients scheduled to undergo elective lower-extremity surgery were enrolled in this double-blind, randomized trial. Spinal anesthesia was administered by using 1 of 2 mixtures. Group B-C received 12.5 mg isobaric 0.5% bupivacaine, 30 mug clonidine, and 0.4 mL 0.9% saline. Group B-C-M received the B-C mixture plus 2 mg of midazolam in a 0.4-mL solution. Motor and sensory block levels were assessed before, during, and after the procedure until regression of the block to S2. Sedation levels were determined before anesthesia, during surgery, and at the end of the procedure. Postoperative analgesia was assessed every 15 minutes by using a visual analog scale. Duration of sensory and motor blocks was determined based on a modified Bromage scale, and time of the first pain relief request was noted.
Duration of sensory block, time of first postoperative analgesic request, and amount of postoperative morphine administered were comparable between groups. However, the motor blockade lasted significantly longer in the B-C-M group compared with the B-C group (287 +/- 73 minutes vs 257 +/- 72 minutes, respectively; P < .05).
Addition of midazolam to an intrathecal B-C mixture does not potentiate postoperative analgesia but prolongs the motor blockade.
先前的临床和实验研究表明，咪达唑仑-可乐定混合物具有协同镇痛作用。本研究评估了在鞘内布比卡因-可乐定混合物中添加咪达唑仑的术后镇痛效果。
110例计划接受择期下肢手术的患者纳入了这项双盲、随机试验。使用两种混合物中的一种进行脊髓麻醉。B-C组接受12.5mg等比重0.5%布比卡因、30μg可乐定和0.4mL 0.9%生理盐水。B-C-M组接受B-C混合物加2mg咪达唑仑于0.4mL溶液中。在手术前、手术期间和手术后评估运动和感觉阻滞平面，直至阻滞消退至S2。在麻醉前、手术期间和手术结束时测定镇静水平。术后每15分钟使用视觉模拟评分法评估镇痛效果。根据改良的 Bromage 量表确定感觉和运动阻滞的持续时间，并记录首次要求缓解疼痛的时间。
两组之间感觉阻滞持续时间、术后首次镇痛要求时间和术后吗啡用量相当。然而，与B-C组相比，B-C-M组运动阻滞持续时间明显更长（分别为287±73分钟和257±72分钟；P<0.05）。
在鞘内B-C混合物中添加咪达唑仑不会增强术后镇痛效果，但会延长运动阻滞时间。
