Parikh Tapan J, Divecha Vishal, Dalwadi Divyang
Department of Anaesthesiology, B J Medical College, Civil Hospital, Ahmedabad, Gujarat, India.
Anesth Essays Res. 2015 Jan-Apr;9(1):28-33. doi: 10.4103/0259-1162.150159.
Many adjuvants are used to increase the efficacy of epidural local anesthetics for postoperative analgesia.
The aim was to compare the efficacy of epidural morphine (0.1 mg/kg) and clonidine (2 μg/kg) with bupivacaine (0.125%) for postoperative analgesia in abdominal surgeries.
Double-blind retrospective randomized study.
All the patients (n = 60) varying from age group belonging to American Society of Anesthesiologists I-II were randomly allocated to receive epidural analgesia Group A - Morphine (0.1 mg/kg). + Bupivacaine (0.125%) (n = 30), Group B - Clonidine (2 μ/kg) + Bupivacaine (0.125%) (n = 30). We monitored vitals and requirement of inhalational gases intra-operatively, pain by visual analogue score (VAS) and vitals postoperatively. We used rescue analgesics (injection diclofenac 1 mg/kg intravenous) when VAS score > 5. Postoperatively, various parameters were monitored for first 2 h at intervals of 30 min and at 4, 8, 12, 16, and 24 hourly intervals after giving 1(st) dose.
Continuous data are analyzed by Student's t-test (paired 't'-test for intragroup variations and unpaired 't'-test for intergroup variations). Chi-square test was used for categorical data. A P ≤ 0.05 was considered to be statistically significant.
Mean duration of analgesia was 8.35 ± 0.42 h in Group A (morphine) and 7.45 ± 0.44 h in Group B (clonidine). This difference was statistically significant (P < 0.001), indicating a prolongation of analgesia in group morphine. There was no need of rescue analgesia in any subjects. Group A patients were hemodynamically stable and required less inhalation agents intra-operatively compared to group B patients.
Epidural morphine plus bupivacaine has a longer duration of analgesia and greater hemodynamic stability as compared to epidural clonidine plus bupivacaine for postoperative analgesia in abdominal surgeries.
许多佐剂被用于提高硬膜外局部麻醉药用于术后镇痛的效果。
目的是比较硬膜外吗啡（0.1毫克/千克）和可乐定（2微克/千克）联合布比卡因（0.125%）用于腹部手术术后镇痛的效果。
双盲回顾性随机研究。
所有年龄在属于美国麻醉医师协会I-II级的患者（n = 60）被随机分配接受硬膜外镇痛，A组——吗啡（0.1毫克/千克）+布比卡因（0.125%）（n = 30），B组——可乐定（2微克/千克）+布比卡因（0.125%）（n = 30）。我们在术中监测生命体征和吸入性气体的需求，术后通过视觉模拟评分（VAS）监测疼痛和生命体征。当VAS评分>5时，我们使用补救镇痛药（双氯芬酸注射液1毫克/千克静脉注射）。术后，在给予首剂后，最初2小时每隔30分钟监测各种参数，之后在4、8、12、16和24小时间隔监测。
连续数据采用学生t检验（组内变异采用配对t检验，组间变异采用非配对t检验）。分类数据采用卡方检验。P≤0.05被认为具有统计学意义。
A组（吗啡组）的平均镇痛持续时间为8.35±0.42小时，B组（可乐定组）为7.45±0.44小时。这种差异具有统计学意义（P<0.001），表明吗啡组的镇痛时间延长。所有受试者均无需补救镇痛。与B组患者相比，A组患者血流动力学稳定，术中所需吸入性药物较少。
与硬膜外可乐定联合布比卡因用于腹部手术术后镇痛相比，硬膜外吗啡联合布比卡因具有更长的镇痛时间和更好的血流动力学稳定性。
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