Rohan Bhatia, Singh Payal Yashwant, Gurjeet Khurana
Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, Uttarakhand 248140, India.
Singapore Med J. 2014 Apr;55(4):229-32. doi: 10.11622/smedj.2014057.
Clonidine is used with local anaesthetics to improve analgesia. However, the improvement conferred when clonidine is used together with ropivacaine is controversial. Thus, the present study aimed to evaluate the improvement in analgesia when clonidine is used together with ropivacaine for supraclavicular brachial plexus block.
This was a prospective, randomised, double-blind controlled study. A total of 75 patients who were scheduled to undergo supraclavicular block were randomly assigned into three groups (i.e. clonidine, lignocaine and control groups) of 25. Patients in all three groups received 20 mL of 0.75% ropivacaine. In addition to that, patients in the clonidine group received 1 mL of clonidine (150 μg) plus 9 mL of saline, patients in the lignocaine group received 10 mL of 2% lignocaine with adrenaline (1:200,000), and patients in the control group received 10 mL of saline. The characteristics of anaesthesia and analgesia for these three groups were assessed.
The addition of 2% lignocaine with adrenaline to ropivacaine led to earlier onset of the sensory block (by 4.88 mins), but no increase in the duration of analgesia when compared to analgesia using ropivacaine alone. The addition of clonidine to ropivacaine led to earlier onset of sensory and motor blocks (by 2.88 mins and 3.28 mins, respectively), as well as an increased duration of sensory and motor blocks (by 222.64 mins and 192.92 mins, respectively) when compared to analgesia using ropivacaine alone. The total duration of analgesia was increased by 208.24 mins with clonidine when compared to analgesia using ropivacaine alone. There were no significant differences in sedation score and no side effects in all three groups.
When compared to the use of ropivacaine alone, the addition of 150 μg clonidine to ropivacaine for brachial plexus block achieved earlier analgesic onset and improved duration of analgesia, without unwanted side effects.
可乐定与局部麻醉药联合使用可改善镇痛效果。然而，可乐定与罗哌卡因联合使用时所带来的改善存在争议。因此，本研究旨在评估可乐定与罗哌卡因联合用于锁骨上臂丛神经阻滞时镇痛效果的改善情况。
这是一项前瞻性、随机、双盲对照研究。总共75例计划接受锁骨上阻滞的患者被随机分为三组（即可乐定组、利多卡因组和对照组），每组25例。三组患者均接受20毫升0.75%的罗哌卡因。此外，可乐定组患者接受1毫升可乐定（150微克）加9毫升生理盐水，利多卡因组患者接受10毫升含肾上腺素（1:200,000）的2%利多卡因，对照组患者接受10毫升生理盐水。评估这三组的麻醉和镇痛特征。
与单独使用罗哌卡因镇痛相比，在罗哌卡因中加入含肾上腺素的2%利多卡因可使感觉阻滞起效更早（提前4.88分钟），但镇痛持续时间无增加。与单独使用罗哌卡因镇痛相比，在罗哌卡因中加入可乐定可使感觉和运动阻滞起效更早（分别提前2.88分钟和3.28分钟），感觉和运动阻滞持续时间增加（分别增加222.64分钟和192.92分钟）。与单独使用罗哌卡因镇痛相比，可乐定使总镇痛持续时间增加208.24分钟。三组的镇静评分无显著差异，且均无副作用。
与单独使用罗哌卡因相比，在罗哌卡因中加入150微克可乐定用于臂丛神经阻滞可实现更早的镇痛起效并改善镇痛持续时间，且无不良副作用。
