Sagiroglu Gonul, Sagiroglu Tamer, Meydan Burhan
Göztepe Education and Research Hospital, Department of Anesthesiology, İstanbul, Turkey.
Kartal Dr. Lütfü Kırdar Education and Research Hospital, Transplantation Center, İstanbul, Turkey.
Eurasian J Med. 2009 Dec;41(3):149-53.
In this study, we compared the clinical effects of combined doses of ropivacaine and clonidine.
Seventy-five patients between ages 18 and 75, in ASA I-III groups who were to undergo elective lower extremity surgery, were included in the study with informed consent. Subjects were randomly assigned to 3 groups. Group I: % 1 ropivacaine 12 mg, group II: % 1 ropivacaine 12 mg + clonidine 15 µg, group III: % 1 ropivacaine 12 mg + clonidine 30 µg. Mean arterial pressure, breathing, heart rate and peripheral oxygen saturation, total amount of ephedrine and atropine used, sensory and motor block levels, level of sedation, pain level and complications were monitored.
The mean arterial pressure recorded in group III decreased significantly at 75, 105 and 120 min compared to groups I and II. In group I, time to two segment regression and time to sensory block to S2 was shorter when compared to the other groups (P<0.0001). The time to voiding and the duration of motor blockade was significantly longer in group I in comparison to the other groups. The need for atropine in group III was significantly higher (P<0.001). The incidence of hypotension and the requirement for ephedrine were significantly higher in groups II and III as compared to group I (P<0.01). Similarly, sedation in group III was significantly higher compared to the other groups (P<0.05).
In summary, our study revealed that clonidine can be added to ropivacaine for spinal anesthesia in surgical interventions to obtain deeper and longer sensory and motor block. However, hypotension, bradycardia and sedation should be monitored closely.
在本研究中,我们比较了不同剂量罗哌卡因与可乐定联合使用的临床效果。
本研究纳入了75例年龄在18至75岁之间、美国麻醉医师协会(ASA)分级为I - III级且拟行择期下肢手术的患者,并获得了他们的知情同意。将受试者随机分为3组。第一组:1%罗哌卡因12毫克;第二组:1%罗哌卡因12毫克 + 可乐定15微克;第三组:1%罗哌卡因12毫克 + 可乐定30微克。监测平均动脉压、呼吸、心率、外周血氧饱和度、麻黄碱和阿托品的总用量、感觉和运动阻滞平面、镇静水平、疼痛程度及并发症。
与第一组和第二组相比,第三组在75、105和120分钟时记录的平均动脉压显著降低。与其他组相比,第一组达到两个节段阻滞的时间和感觉阻滞至S2的时间更短(P<0.0001)。与其他组相比,第一组排尿时间和运动阻滞持续时间显著更长。第三组阿托品的需求量显著更高(P<0.001)。与第一组相比,第二组和第三组低血压的发生率及麻黄碱的需求量显著更高(P<0.01)。同样,与其他组相比,第三组的镇静程度显著更高(P<0.05)。
总之,我们的研究表明,在手术干预的脊髓麻醉中,可乐定可添加到罗哌卡因中,以获得更深、更长时间的感觉和运动阻滞。然而,应密切监测低血压、心动过缓和镇静情况。