Sen Jayashree, Sen Bitan
Department of Anesthesia, Goldfield Institute of Medical Sciences and Research, Ballabgargh, Faridabad, India.
Department of Emergency Medicine, Apollo Hospital, New Delhi, India.
Saudi J Anaesth. 2015 Apr-Jun;9(2):142-7. doi: 10.4103/1658-354X.152840.
Clonidine, an alpha-2-adrenergic agonist, may have a clinically relevant analgesic action but also a hypotensive action, when administered spinally.
To evaluate the analgesic and circulatory effects of low-dose intrathecal clonidine co-administered with hyperbaric bupivacaine in septuagenarian patients undergoing sub-umbilical surgeries.
A total of 20 patients within the age group of 70-80 years of either sex, enrolled in this study, were randomly divided into groups of 10 each. Group I received clonidine 7.5 μg as an adjuvant to 15 mg of hyperbaric bupivacaine and Group II (control group) received 15 mg of bupivacaine with saline to make volume in the two solutions equal.
The level of subarachnoid block was comparable in the two groups. Duration of motor blockade was longer in the clonidine group (221.4 ± 35.92 min) compared with the control group (112.3 ± 12.45 min). Request for 1(st) dose of analgesic was earlier in the control group (135.5 ± 28.52 min) than the clonidine group (295 ± 18.85 min). Mean arterial pressure (clonidine 77.67 ± 6.47 vs. control 93.87 ± 3.03, P = 0.0002) and heart rate (clonidine 65.2 ± 5.20 vs. control 77.4 ± 6.06, P = 0.003) were significantly lower (P < 0.05) in the clonidine group compared with the control group from 20 mins after the block to the end of 3 h. In the clonidine group, 3 patients had postoperative headache, 4 had intra-operative shivering. 2 patients in the clonidine group also developed hypotension and 1 bradycardia and 1 of them developed bradyapnea along with acute hypotension 5 min after shifting to the postoperative ward and later recovered on resuscitation. In the control group 2 patients had bradycardia, 6 had intra-operative shivering and 3 had postoperative headache.
We conclude that addition of clonidine in the dose of 7.5 μg to bupivacaine significantly increases the duration of spinal analgesia with clinically insignificant influence on hemodynamic parameters.
可乐定是一种α2肾上腺素能激动剂，经脊髓给药时可能具有临床相关的镇痛作用，但也有降压作用。
评估在接受脐下手术的老年患者中，低剂量鞘内注射可乐定与高压布比卡因联合使用的镇痛和循环效应。
本研究共纳入20例年龄在70 - 80岁之间的患者，随机分为两组，每组10例。第一组接受7.5μg可乐定作为15mg高压布比卡因的辅助剂，第二组（对照组）接受15mg布比卡因加生理盐水，使两种溶液体积相等。
两组蛛网膜下腔阻滞水平相当。可乐定组运动阻滞持续时间（221.4±35.92分钟）长于对照组（112.3±12.45分钟）。对照组首次使用镇痛药的时间（135.5±28.52分钟）早于可乐定组（295±18.85分钟）。从阻滞20分钟后至3小时结束，可乐定组的平均动脉压（可乐定77.67±6.47 vs.对照组93.87±3.03，P = 0.0002）和心率（可乐定65.2±5.20 vs.对照组77.4±6.06，P = 0.003）显著低于对照组（P < 0.05）。可乐定组有3例患者术后头痛，4例术中寒战。可乐定组有2例患者出现低血压，1例心动过缓，其中1例在转入术后病房5分钟后出现心动过缓和急性低血压，经复苏后恢复。对照组有2例患者心动过缓，6例术中寒战，3例术后头痛。
我们得出结论，在布比卡因中添加7.5μg可乐定可显著延长脊髓镇痛时间，对血流动力学参数的影响在临床上无显著意义。
