一项评估硬膜外注射硫酸镁和可乐定作为布比卡因辅助剂用于开胸术后镇痛的疗效和安全性的随机双盲研究。
A randomized double-blind study to evaluate efficacy and safety of epidural magnesium sulfate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief.
作者信息
Mohammad Wasim, Mir Shafat A, Mohammad Khairaat, Sofi Khalid
机构信息
Department of Anaesthesiology and Critical Care, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
出版信息
Anesth Essays Res. 2015 Jan-Apr;9(1):15-20. doi: 10.4103/0259-1162.150141.
BACKGROUND
The aim of the study was to compare postoperative pain relief in patients undergoing an elective thoracotomy with thoracic epidural analgesia using single shot magnesium and clonidine as adjuvants to bupivacaine.
METHODS
In a randomized prospective study, 60 patients of American Society of Anesthesiologists physical status I-III of either sex, between 20 and 60 years undergoing elective unilateral thoracotomy, were allocated to three equal groups of 20 patients. Each patient received thoracic epidural analgesia using bupivacaine alone (Group A) or with magnesium (Group B) or clonidine (Group C) at the end of surgery during skin closure. Postoperatively, pain was measured using a visual analog scale (VAS). Rescue analgesia (50 mg tramadol intravenous) was given at a VAS score of ≥4. Duration of analgesia and total dose of rescue analgesic during 24 h was calculated. Postoperative sedation and other side effects if any were recorded.
RESULTS
All the groups were homogeneous with respect to their demographics. The 24 h cumulative mean VAS score in Groups A, B, and C was 3.12 ± 0.97, 2.86 ± 0.43, and 1.83 ± 0.59, respectively. The duration of analgesia was prolonged in Group C (165 ± 49.15 min), followed by Group B (138 ± 24.6 min), and Group A (118.5 ± 52.8 min). The duration of analgesia was significantly prolonged in the clonidine group as compared to the control group (P = 0.001). The number of rescue analgesia doses were more in Group A (3.3 ± 1.65) followed by Group B (2.35 ± 0.98) and Group C (1.75 ± 0.71). The sedation scores were significantly higher in Group C. However, shivering was seen in Group A (40%) and Group C (20%) and absent in Group B (P = 0.003).
CONCLUSION
Thoracic epidural analgesia using bupivacaine with clonidine is an efficient therapeutic modality for postthoracotomy pain. Magnesium as an adjuvant provided quality postoperative analgesia decreasing the need for postoperative rescue analgesia and incidence of postoperative shivering without causing sedation.
背景
本研究旨在比较在择期开胸手术患者中，使用单次注射镁剂和可乐定作为布比卡因辅助剂进行胸段硬膜外镇痛后的疼痛缓解情况。
方法
在一项随机前瞻性研究中，将60例年龄在20至60岁之间、美国麻醉医师协会身体状况分级为I - III级、接受择期单侧开胸手术的患者，随机分为三组，每组20例。每组患者均在手术结束皮肤缝合时接受胸段硬膜外镇痛，其中A组仅使用布比卡因，B组使用布比卡因加镁剂，C组使用布比卡因加可乐定。术后，使用视觉模拟评分法（VAS）测量疼痛程度。当VAS评分≥4分时，给予补救镇痛（静脉注射50mg曲马多）。计算24小时内的镇痛持续时间和补救镇痛药的总剂量。记录术后镇静情况及其他任何副作用。
结果
所有组在人口统计学方面具有同质性。A组、B组和C组24小时累积平均VAS评分分别为3.12±0.97、2.86±0.43和1.83±0.59。C组的镇痛持续时间延长（165±49.15分钟），其次是B组（138±24.6分钟）和A组（118.5±52.8分钟）。与对照组相比，可乐定组的镇痛持续时间显著延长（P = 0.001）。补救镇痛药剂量A组最多（3.3±1.65），其次是B组（2.35±0.98）和C组（1.75±0.71）。C组的镇静评分显著更高。然而，A组（40%）和C组（20%）出现寒战，B组未出现（P = 0.003）。
结论
布比卡因联合可乐定用于胸段硬膜外镇痛是开胸术后疼痛的一种有效治疗方式。镁剂作为辅助剂可提供优质的术后镇痛，减少术后补救镇痛的需求以及术后寒战的发生率，且不会引起镇静。
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