Department of Anaesthesia and Intensive Care and.
Br J Anaesth. 2013 Oct;111(4):656-61. doi: 10.1093/bja/aet130. Epub 2013 May 22.
This randomized double-blind study was designed to compare the postoperative analgesic effect of clonidine administered intravenously or in wound infiltration with bupivacaine.
Sixty adults of ASA grade I-II undergoing open cholecystectomy were randomly allocated into three groups. Group 1 (control group) patients received wound infiltration with 30 ml of 0.25% bupivacaine at the end of surgery. Group 2 patients received 3 μg kg(-1) clonidine intravenously after resection of gall bladder plus wound infiltration with 30 ml of 0.25% bupivacaine. Group 3 patients received wound infiltration with 3 μg kg(-1) clonidine with 30 ml of 0.25% bupivacaine. A standard general anaesthesia technique was used. Postoperative analgesia was provided with i.v. diclofenac and morphine on demand. Postoperative pain, number of patients requiring rescue analgesia and total morphine consumption during 24 h after operation was recorded.
Postoperative morphine consumption was significantly less in patients receiving clonidine by either route when compared with the control group (P<0.0001). All patients in the control group required supplemental morphine, with nine patients in the i.v. clonidine group and 11 patients in the wound infiltration group (P<0.002). Pain scores were lower at rest for 12 h and on cough for 6 h in both clonidine groups when compared with the control group (P<0.01). Patients receiving i.v. clonidine had more hypotension (P<0.01) and sedation (P<0.001) compared with other groups.
Clonidine 3 μg kg(-1) provided effective postoperative analgesia and reduced morphine requirement when administered intravenously or in wound infiltration with bupivacaine. However, the incidence of complications was less with wound infiltration. CLINICAL TRIAL REGISTRY OF INDIA: (www.ctri.nic.in/), registration number CTRI/2012/12/003258.
本随机双盲研究旨在比较氯胺酮静脉注射或局部浸润用于布比卡因术后镇痛的效果。
60 名 ASA 分级 I-II 级的成年人接受开放性胆囊切除术，随机分为三组。第 1 组（对照组）患者在手术结束时接受 30ml0.25%布比卡因的伤口浸润。第 2 组患者切除胆囊后静脉注射 3μg/kg氯胺酮，同时给予 30ml0.25%布比卡因伤口浸润。第 3 组患者给予 3μg/kg氯胺酮和 30ml0.25%布比卡因的伤口浸润。采用标准全身麻醉技术。术后按需静脉注射双氯芬酸和吗啡进行镇痛。记录术后疼痛、需要解救镇痛的患者人数和术后 24 小时内吗啡总消耗量。
与对照组相比，任何途径给予氯胺酮的患者术后吗啡消耗量明显减少（P<0.0001）。对照组所有患者均需要补充吗啡，静脉注射氯胺酮组有 9 例，伤口浸润组有 11 例（P<0.002）。与对照组相比，两组氯胺酮组在静息时疼痛评分在 12 小时和咳嗽时疼痛评分在 6 小时均较低（P<0.01）。与其他组相比，静脉注射氯胺酮组出现更多低血压（P<0.01）和镇静（P<0.001）。
氯胺酮 3μg/kg 静脉注射或局部浸润布比卡因均可提供有效术后镇痛，并减少吗啡需求。然而，局部浸润的并发症发生率较低。印度临床试验注册处（www.ctri.nic.in/），注册号 CTRI/2012/12/003258。
