Pöpping Daniel M, Elia Nadia, Marret Emmanuel, Wenk Manuel, Tramèr Martin R
Department of Anesthesiology and Intensive Care, University Hospital Münster, Münster, Germany.
Anesthesiology. 2009 Aug;111(2):406-15. doi: 10.1097/ALN.0b013e3181aae897.
The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. The authors searched for randomized placebo-controlled trials testing the impact of adding clonidine to local anesthetics for peripheral single-injection nerve or plexus blocks in adults undergoing any surgery (except eye) without general anesthesia. Twenty trials (1,054 patients, 573 received clonidine) published 1992-2006 tested plexus (14 brachial, 1 cervical) and nerve blocks (2 sciatic/femoral, 1 midhumeral, 1 ilioinguinal/iliohypogastric, 1 ankle). Clonidine doses ranged from 30 to 300 microg; most patients received 150 microg. Clonidine prolonged the duration of postoperative analgesia (weighted mean difference 122 min; 95% confidence interval [CI] 74-169), sensory block (weighted mean difference 74 min; 95% CI 37-111), and motor block (weighted mean difference 141 min; 95% CI 82-199). In a subgroup of patients receiving an axillary plexus block, these effects were independent of whether clonidine was added to an intermediate or a long-acting local anesthetic. Clonidine increased the risk of arterial hypotension (odds ratio 3.61; 95% CI 1.52-8.55; number-needed-to-harm 11), orthostatic hypotension or fainting (odds ratio 5.07; 95% CI 1.20-21.4; number-needed-to-harm 10), bradycardia (odds ratio 3.09; 95% CI 1.10-8.64; number-needed-to-harm 13), and sedation (odds ratio 2.28; 95% CI 1.15-4.51; number-needed-to-harm 5). There was a lack of evidence of dose-responsiveness for beneficial or harmful effects. Clonidine added to intermediate or long-acting local anesthetics for single-shot peripheral nerve or plexus blocks prolongs duration of analgesia and motor block by about 2 h. The increased risk of hypotension, fainting, and sedation may limit its usefulness. Dose-responsiveness remains unclear.
在局部麻醉药中添加可乐定用于神经或神经丛阻滞的效果仍不明确。作者检索了随机安慰剂对照试验，这些试验测试了在未接受全身麻醉的接受任何手术（眼科手术除外）的成人中，在局部麻醉药中添加可乐定用于外周单次注射神经或神经丛阻滞的影响。1992年至2006年发表的20项试验（1054例患者，573例接受可乐定）测试了神经丛（14例臂丛、1例颈丛）和神经阻滞（2例坐骨神经/股神经、1例肱骨中段、1例髂腹股沟/髂腹下神经、1例踝关节）。可乐定剂量范围为30至300微克；大多数患者接受150微克。可乐定延长了术后镇痛时间（加权平均差122分钟；95%置信区间[CI]74 - 169）、感觉阻滞时间（加权平均差74分钟；95%CI 37 - 111）和运动阻滞时间（加权平均差141分钟；95%CI 82 - 199）。在接受腋路臂丛阻滞的患者亚组中，这些效应与可乐定是添加到中效还是长效局部麻醉药中无关。可乐定增加了动脉低血压风险（比值比3.61；95%CI 1.52 - 8.55；伤害需治人数11）、体位性低血压或昏厥风险（比值比5.07；95%CI 1.20 - 21.4；伤害需治人数10）、心动过缓风险（比值比3.09；95%CI 1.10 - 8.64；伤害需治人数13）和镇静风险（比值比2.28；95%CI 1.15 - 4.51；伤害需治人数5）。缺乏有益或有害效应剂量反应性的证据。添加到中效或长效局部麻醉药中的可乐定用于单次外周神经或神经丛阻滞可将镇痛和运动阻滞时间延长约2小时。低血压、昏厥和镇静风险增加可能会限制其应用。剂量反应性仍不明确。
