Van de Velde M, Berends N, Kumar A, Devroe S, Devlieger R, Vandermeersch E, De Buck F
Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.
Int J Obstet Anesth. 2009 Jul;18(3):207-14. doi: 10.1016/j.ijoa.2009.01.003. Epub 2009 May 17.
The limited duration of spinal labour analgesia combined with problems associated with maintenance of epidural analgesia, have prompted the search for combinations that could prolong spinal analgesia. A randomised, double-blind trial was carried out to test the hypotheses (a) that initial spinal labour analgesia is prolonged by administering clonidine and neostigmine epidurally whilst (b) the hourly local anaesthetic consumption is reduced.
Seventy labouring patients received spinal analgesia with ropivacaine and sufentanil. Fifteen minutes after spinal injection, 10 mL of study solution was administered epidurally. The study solution was plain saline or neostigmine 500 microg combined with clonidine 75 microg. Outcome parameters were duration of spinal analgesia, local anaesthetic consumption and number of patients delivering without additional epidural analgesia.
Epidural clonidine and neostigmine significantly prolonged initial analgesia: 144 (105-163) min vs. 95 (70-120) min in the placebo group and reduced hourly ropivacaine consumption: 7.5 (3.0-11.9) mg vs. 12.7 (9.6-16.9) mg. More patients in the experimental group delivered before the first request for additional analgesia (9 vs. 2).
Epidural administration of neostigmine 500 microg and clonidine 75 microg, following the intrathecal injection of ropivacaine and sufentanil, prolongs analgesia and reduces hourly ropivacaine consumption.
脊髓分娩镇痛持续时间有限，且与硬膜外镇痛维持相关的问题，促使人们寻找可延长脊髓镇痛的联合用药方案。开展了一项随机双盲试验，以检验以下假设：（a）硬膜外给予可乐定和新斯的明可延长初始脊髓分娩镇痛时间；（b）每小时局部麻醉药消耗量会减少。
70例分娩患者接受了罗哌卡因和舒芬太尼脊髓镇痛。脊髓注射后15分钟，硬膜外给予10 mL研究溶液。研究溶液为生理盐水或500微克新斯的明与75微克可乐定的混合液。观察指标包括脊髓镇痛持续时间、局部麻醉药消耗量以及无需额外硬膜外镇痛分娩的患者数量。
硬膜外给予可乐定和新斯的明显著延长了初始镇痛时间：试验组为144（105 - 163）分钟，而安慰剂组为95（70 - 120）分钟；同时降低了每小时罗哌卡因消耗量：试验组为7.5（3.0 - 11.9）毫克，安慰剂组为12.7（9.6 - 16.9）毫克。试验组更多患者在首次要求追加镇痛前分娩（9例 vs. 2例）。
鞘内注射罗哌卡因和舒芬太尼后，硬膜外给予500微克新斯的明和75微克可乐定，可延长镇痛时间并降低每小时罗哌卡因消耗量。
