Niyogi Saikat, Santra Sankari, Chakraborty Jayanta, Chakraborty Sushmita, Mandal Srikrishna, Mondal C R
Department of Anaesthesiology, BIN, Kolkata 700025.
J Indian Med Assoc. 2011 Apr;109(4):230-3.
A randomised prospective double-blind placebo controlled study was undertaken in 60 patients of ASA-I and II, scheduled for lumbar laminectomy under general anaesthesia using thiopentone, fentanyl, artracurium, N2O/O2 and isoflurane. After obtaining written Informed consent from all patients, they were randomly allocated to two equal groups ie, group A (n = 30) and group B (n = 30). Group A patients received clonidine 0.5 ml (75 microg) plus 5 ml 0.25% bupivacaine and group B patients received 5 ml 0.25% bupivacaine plus 0.5 ml of normal saline (NS) as a control through epidural route placed by the surgeon at the closure of the surgery. All the vital parameters were recorded at the time of epidural catheter placement and administering drugs and at 10 minutes interval thereafter till the patients were reversed with neostigmine and glycopyrrolate and then in the postanaesthetic care unit (PACU) at 15 minutes interval till the end of the study. All patients received injection diclofenac 75 mg IM as soon as they complained of pain or when the VAS score became > or = 4cm. The study ended when patients received injection diclofenac 75 mg IM as rescue analgesic. Any feature of motor block, sedation score and event of urinary retention were recorded in the PACU. Duration of postoperative analgesia was taken as the primary outcome and measured from the time of regaining full consciousness following surgery till receiving first injection of rescue analgesic in the PACU. Duration of postoperative analgesia was (546.36 +/- 11.55 minutes) in group A compared to (240.15 +/- 07.32 minutes) in group B. No clinically significant difference was found in heart rate, blood pressure, respiratory rate, oxygen saturation and motor blockade. Sedation score was slightly higher in group A, which was not significant. So small dose of clonidine (75 microg) as an adjuvant to 5 ml 0.25% bupivacaine in epidural route following lumbar laminectomy significantly prolonged postoperative analgesia and improved patient satisfaction without any clinically significant adverse reaction.
对60例ASA-I级和II级患者进行了一项随机前瞻性双盲安慰剂对照研究，这些患者计划在全身麻醉下使用硫喷妥钠、芬太尼、阿曲库铵、N2O/O2和异氟烷进行腰椎椎板切除术。在获得所有患者的书面知情同意后，将他们随机分为两组，即A组（n = 30）和B组（n = 30）。A组患者通过外科医生在手术结束时经硬膜外途径接受0.5 ml可乐定（75微克）加5 ml 0.25%布比卡因，B组患者接受5 ml 0.25%布比卡因加0.5 ml生理盐水（NS）作为对照。在硬膜外导管置入和给药时以及此后每隔10分钟记录所有生命体征参数，直到患者用新斯的明和格隆溴铵逆转，然后在麻醉后护理单元（PACU）每隔15分钟记录一次，直至研究结束。所有患者一旦主诉疼痛或视觉模拟评分（VAS）≥4 cm，即接受75 mg双氯芬酸肌内注射。当患者接受75 mg双氯芬酸肌内注射作为解救镇痛药时，研究结束。在PACU记录任何运动阻滞、镇静评分和尿潴留事件。术后镇痛持续时间作为主要结局，从手术后恢复完全清醒到在PACU接受首次解救镇痛药注射的时间进行测量。A组术后镇痛持续时间为（546.36±11.55分钟），而B组为（240.15±7.32分钟）。在心率、血压、呼吸频率、血氧饱和度和运动阻滞方面未发现临床显著差异。A组的镇静评分略高，但无统计学意义。因此，在腰椎椎板切除术后经硬膜外途径将小剂量可乐定（75微克）作为5 ml 0.25%布比卡因的辅助药物可显著延长术后镇痛时间并提高患者满意度，且无任何临床显著不良反应。
