在用于上肢手术的锁骨下臂丛神经阻滞中，地塞米松与可乐定作为1.5%利多卡因加肾上腺素辅助用药的比较。
Comparison of dexamethasone and clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries.
作者信息
Shah Dipal Mahendra, Arora Mahesh, Trikha Anjan, Prasad Ganga, Sunder Rani, Kotwal Prakash, Singh Preet Mohinder
机构信息
Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
出版信息
J Anaesthesiol Clin Pharmacol. 2015 Jul-Sep;31(3):354-9. doi: 10.4103/0970-9185.161672.
BACKGROUND AND AIMS
The role of clonidine as an adjuvant to regional blocks to hasten the onset of the local anesthetics or prolong their duration of action is proven. The efficacy of dexamethasone compared to clonidine as an adjuvant is not known. We aimed to compare the efficacy of dexamethasone versus clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries.
MATERIAL AND METHODS
Fifty three American Society of Anaesthesiologists-I and II patients aged 18-60 years scheduled for upper limb surgery were randomized to three groups to receive 1.5% lignocaine with 1:200,000 adrenaline and the study drugs. Group S (n = 13) received normal saline, group D (n = 20) received dexamethasone and group C (n = 20) received clonidine. The time to onset and peak effect, duration of the block (sensory and motor) and postoperative analgesia requirement were recorded. Chi-square and ANOVA test were used for categorical and continuous variables respectively and Bonferroni or post-hoc test for multiple comparisons. P < 0.05 was considered significant.
RESULTS
The three groups were comparable in terms of time to onset and peak action of motor and sensory block, postoperative analgesic requirements and pain scores. 90% of the blocks were successful in group C compared to only 60% in group D (P = 0.028). The duration of sensory and motor block in group S, D and C were 217.73 ± 61.41 min, 335.83 ± 97.18 min and 304.72 ± 139.79 min and 205.91 ± 70.1 min, 289.58 ± 78.37 min and 232.5 ± 74.2 min respectively. There was significant prolongation of sensory and motor block in group D as compared to group S (P < 0.5). Time to first analgesic requirement was significantly more in groups C and D as compared with group S (P < 0.5). Clinically significant complications were absent.
CONCLUSIONS
We conclude that clonidine is more efficacious than dexamethasone as an adjuvant to 1.5% lignocaine in brachial plexus blocks.
背景与目的
可乐定作为区域阻滞辅助药物以加速局部麻醉药起效或延长其作用持续时间的作用已得到证实。地塞米松作为辅助药物与可乐定相比的疗效尚不清楚。我们旨在比较地塞米松与可乐定作为辅助药物用于上肢手术的锁骨下臂丛神经阻滞中1.5%利多卡因加肾上腺素的疗效。
材料与方法
53例年龄在18至60岁、美国麻醉医师协会分级为Ⅰ级和Ⅱ级、计划行上肢手术的患者被随机分为三组，接受1.5%利多卡因加1:200,000肾上腺素及研究药物。S组（n = 13）接受生理盐水，D组（n = 20）接受地塞米松，C组（n = 20）接受可乐定。记录起效时间、达到峰值效应的时间、阻滞持续时间（感觉和运动）以及术后镇痛需求。分别使用卡方检验和方差分析来分析分类变量和连续变量，使用Bonferroni检验或事后检验进行多重比较。P < 0.05被认为具有统计学意义。
结果
三组在运动和感觉阻滞的起效时间、达到峰值效应的时间、术后镇痛需求和疼痛评分方面具有可比性。C组90%的阻滞成功，而D组仅为60%（P = 0.028）。S组、D组和C组的感觉和运动阻滞持续时间分别为217.73±61.41分钟、335.83±97.18分钟和304.72±139.79分钟，以及205.91±70.1分钟、289.58±78.37分钟和232.5±74.2分钟。与S组相比，D组的感觉和运动阻滞时间显著延长（P < 0.05）。与S组相比，C组和D组首次需要镇痛的时间显著更长（P < 0.05）。未出现具有临床意义的并发症。
结论
我们得出结论，在臂丛神经阻滞中，可乐定作为1.5%利多卡因的辅助药物比地塞米松更有效。
Zotero 插件