鞘内注射可乐定与芬太尼对经尿道前列腺切除术布比卡因脊髓阻滞的影响。
Effect of intrathecal clonidine versus fentanyl on bupivacaine spinal block in transurethral resection of prostate surgeries.
作者信息
Singh Gurpreet, Aulakh Gurmehar Singh, Aulakh Navpreet Kaur, Singh Rupinder Mirley, Bose Abhishek, Katayal Sunil, Aulakh Baldev Singh
机构信息
Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
SGRD Medical College, Amritsar, Punjab, India.
出版信息
Anesth Essays Res. 2016 Jan-Apr;10(1):65-70. doi: 10.4103/0259-1162.165513.
AIMS
Our study aimed at comparing the onset, degree and recovery time of sensory and motor block, the hemodynamic effects and postoperative pain relief using intrathecal bupivacaine alone, bupivacaine along with fentanyl and clonidine.
MATERIALS AND METHODS
A total of 90 patients, undergoing transurethral resection of prostate (TURP) surgeries under spinal anesthesia were studied. Patients were randomly divided in a double-blind manner into three groups of 30 patients each. Group A (control) patients given subarachnoid block with 0.5% hyperbaric bupivacaine with 0.5 ml of normal saline. Group B patients were given subarachnoid block with 0.5% hyperbaric bupivacaine along with fentanyl 25 μg. Group C patients were given subarachnoid block with 0.5% hyperbaric bupivacaine 10 mg along with clonidine 30 μg and 0.3 ml of normal saline. After administering the subarachnoid block, vitals were recorded before and after surgery. Level of sensory block, the duration of motor block (DOMB), duration of sensory blockade (DOSB), the quality of postoperative analgesia using linear visual analog scale (VAS), and side effects were evaluated.
RESULTS
The time required to attain a maximum height of the block was significantly more in Group B as compared to Groups A and C, which was statistically significant. However, there was no statistically significant difference between Groups A and C. The mean DOSB in Groups A, B, and C were 90.83 ± 9.48 min, 135.33 ± 12.59 min, and 155.17 ± 17.49 min, respectively. The mean DOMB in Groups A, B, and C were 83.83 ± 6.52 min, 115.50 ± 14.70 min and 120.67 ± 11.50, respectively. Time of the first request of analgesia in Groups A, B and C in postoperative period were 132.50 ± 21.53 min, 296.00 ± 50.07 min, and 311.83 ± 65.34 min. patients had. VAS was significantly of higher value in Group A than Groups B and C.
CONCLUSIONS
Intrathecal clonidine in a combination of bupivacaine for TURP provides more satisfactory anesthesia and analgesia and has less side effects.
目的
我们的研究旨在比较单独使用鞘内布比卡因、布比卡因联合芬太尼和可乐定的感觉和运动阻滞的起效时间、程度及恢复时间、血流动力学效应和术后疼痛缓解情况。
材料与方法
共研究了90例在脊髓麻醉下接受经尿道前列腺切除术（TURP）的患者。患者以双盲方式随机分为三组，每组30例。A组（对照组）患者接受蛛网膜下腔阻滞，使用0.5%重比重布比卡因加0.5ml生理盐水。B组患者接受蛛网膜下腔阻滞，使用0.5%重比重布比卡因联合25μg芬太尼。C组患者接受蛛网膜下腔阻滞，使用10mg 0.5%重比重布比卡因联合30μg可乐定和0.3ml生理盐水。给予蛛网膜下腔阻滞后，记录手术前后的生命体征。使用线性视觉模拟量表（VAS）评估感觉阻滞水平、运动阻滞持续时间（DOMB）、感觉阻滞持续时间（DOSB）、术后镇痛质量及副作用。
结果
与A组和C组相比，B组达到最大阻滞高度所需时间明显更长，具有统计学意义。然而，A组和C组之间无统计学显著差异。A组、B组和C组的平均DOSB分别为90.83±9.48分钟、135.33±12.59分钟和155.17±17.49分钟。A组、B组和C组的平均DOMB分别为83.83±6.52分钟、115.50±14.70分钟和120.67±11.50分钟。术后A组、B组和C组首次要求镇痛的时间分别为132.50±21.53分钟、296.00±50.07分钟和311.83±65.34分钟。A组患者的VAS值显著高于B组和C组。
结论
布比卡因联合鞘内可乐定用于TURP可提供更满意的麻醉和镇痛效果，且副作用更少。
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