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可乐定作为辅助药物与高压布比卡因联合用于老年下肢骨科手术患者的脊髓麻醉。

Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries.

作者信息

Agarwal Deepti, Chopra Manish, Mohta Medha, Sethi Ashok Kumar

机构信息

Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.

出版信息

Saudi J Anaesth. 2014 Apr;8(2):209-14. doi: 10.4103/1658-354X.130720.

Abstract

BACKGROUND

In elderly patients, use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in elderly without affecting the side-effects if any of clonidine in these patients.

MATERIALS AND METHODS

This was a prospective, randomized, double-blind study. Above 60 years male patients were allocated to three equal groups. Group C received 9 mg hyperbaric bupivacaine without clonidine while Group C15 and Group C30 received 15 μg and 30 μg clonidine with hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied.

RESULTS

A significantly higher median block levels were achieved in Group C15 (P < 0.001) and Group C30 (P = 0.015) than Group C. Highest median sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically significant between Groups C15 and C and between Groups C30 and C. On comparison of fall in systolic blood pressure trends, there was no significant difference in the clonidine groups as compared with the control group.

CONCLUSIONS

In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, significantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

摘要

背景

在老年患者中,使用小剂量局部麻醉药辅助进行脊髓麻醉是下肢手术脊髓麻醉的首选技术。本研究检验了以下假设:添加小剂量可乐定可增强高压布比卡因在老年患者中产生的脊髓阻滞平面,且不影响这些患者中可乐定的任何副作用。

材料与方法

这是一项前瞻性、随机、双盲研究。60岁以上男性患者被分为三个相等的组。C组接受9mg无可乐定的高压布比卡因,而C15组和C30组分别接受15μg和30μg可乐定与高压布比卡因用于脊髓麻醉。可乐定对感觉阻滞平面的影响是主要研究结局指标。还研究了运动阻滞和血流动力学参数。

结果

C15组(P < 0.001)和C30组(P = 0.015)的中位阻滞平面显著高于C组。C15组与C组之间以及C30组与C组之间,最高中位感觉阻滞平面、感觉恢复至T12水平的平均时间和运动阻滞恢复时间具有统计学意义。比较收缩压下降趋势时,可乐定组与对照组之间无显著差异。

结论

在老年患者中,与单独使用布比卡因相比,可乐定与布比卡因鞘内注射剂量为15μg或30μg时,可显著增强感觉阻滞平面和镇痛持续时间,且不影响收缩压趋势。然而,30μg剂量的可乐定使感觉平面阻滞上升到意外更高的皮节并持续更长时间。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/13cc/4024678/9c714187eddf/SJA-8-209-g002.jpg

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