Lak Marzieh, Araghizadeh Hasan, Shayeghi Shahnas, Khatibi Behroz
Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
Department of Anesthesiology, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
Trauma Mon. 2012 Jan;16(4):170-4. doi: 10.5812/kowsar.22517464.3393. Epub 2012 Jan 15.
Pain in infancy is a developmental process. Due to the underdeveloped pain pathways in the spinal cord, the threshold of stimulation and sensation of pain is low at birth and has potential impacts on increasing the central effects of pain. Primary trauma during infancy can cause long term changes in structure and function of pain pathways that continue until adulthood. Lack of pain management in children can result in morbidity and mortality.
In this study we examined the duration of post-operative analgesia in children when clonidine is added to bupivacaine in caudal anesthesia.
In this clinical trial, 40 children aged 1-8 years who were candidates for elective inguinal hernia repair were studied. Induction and maintenance of anesthesia were achieved using sodium thiopenthal, halothane and nitrous oxide. Children were randomly divided into 2 groups in a double-blind fashion, and were given caudal anesthesia with 0.125% bupivacaine (1ml/kg) alone or b bupivacaine plus 2 μg/kg clonidine. Blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated using objective pain scale (OPS) and sedation was assessed using Ramsay sedation scale (RSS). Acetaminophen was administered rectally for cases with OPS score greater than five.
Duration of analgesia was found to be significantly longer in the group given bupivacaine plus clonidine (mean 417.50 min vs. 162.00 min). Peri-operative hypotension or bradycardia, post-operative respiratory depression, nausea or vomiting were not recorded in any patient.
We concluded that addition of clonidine to bupivacaine prolongs the duration of post-operative analgesia without any respiratory or hemodynamic side-effects.
婴儿期疼痛是一个发育过程。由于脊髓中疼痛传导通路发育不完善，出生时疼痛刺激和感觉阈值较低，这可能会增加疼痛的中枢效应。婴儿期的原发性创伤可导致疼痛传导通路的结构和功能发生长期变化，并持续至成年期。儿童缺乏疼痛管理可导致发病和死亡。
在本研究中，我们探讨了在骶管麻醉中布比卡因加入可乐定后儿童术后镇痛的持续时间。
在这项临床试验中，研究了40例1-8岁择期行腹股沟疝修补术的儿童。使用硫喷妥钠、氟烷和氧化亚氮进行麻醉诱导和维持。儿童以双盲方式随机分为2组，分别单独给予0.125%布比卡因（1ml/kg）或布比卡因加2μg/kg可乐定进行骶管麻醉。围手术期记录血压和心率。使用客观疼痛量表（OPS）评估镇痛效果，使用拉姆齐镇静量表（RSS）评估镇静效果。对于OPS评分大于5分的病例，经直肠给予对乙酰氨基酚。
发现布比卡因加可乐定组的镇痛持续时间明显更长（平均417.50分钟对162.00分钟）。所有患者均未记录到围手术期低血压或心动过缓、术后呼吸抑制、恶心或呕吐。
我们得出结论，布比卡因中加入可乐定可延长术后镇痛时间，且无任何呼吸或血流动力学副作用。
