Prasad Rachna, Rao Rs Raghavendra, Turai Ashwini, Prabha P, Shreyavathi R, Harsoor Karuna
Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Indian J Anaesth. 2016 Jun;60(6):398-402. doi: 10.4103/0019-5049.183395.
Combined spinal-epidural (CSE) anaesthesia is being increasingly used for effective post-operative analgesia. This study was designed to evaluate the effect of epidural clonidine on characteristics of spinal anaesthesia for gynaecological surgeries.
This was a prospective randomised, double-blind, controlled study involving sixty patients belonging to American Society of Anesthesiologists Physical Status I and II who underwent gynaecological surgeries were randomly divided into clonidine (C) group and saline (S) group of thirty each. All patients received CSE anaesthesia. Ten minutes before subarachnoid block (SAB), Group C received clonidine 150 μg diluted to 5 ml in normal saline (NS) and Group S received NS epidurally. Hyperbaric bupivacaine (15 mg) was administered intrathecally for both groups after epidural injection. Sensory and motor block characteristics, analgesia, sedation and haemodynamics were observed. Statistical analysis was performed using appropriate tests.
Epidural clonidine produced faster onset (37.83 ± 8.58 s in Group C compared to 50.33 ± 8.80 s in Group S, P = 0.001) and prolonged duration of sensory block (241.17±18.65 minutes in group C compared to 150.33±19.16 minutes in group S, P = 0.001). Time for two segment regression of sensory block was193.67 ± 19.82 min in Group C and 109.33 ± 18.56 min Group S (P < 0.001). The duration of analgesia was 299.00 ± 43.38 min in Group C and 152.50 ± 21.04 min in Group S (P < 0.001). Haemodynamics and sedation scores were comparable between two groups.
Administration of clonidine epidurally, 10 min before SAB, caused early onset and prolonged duration of motor blockade and analgesia, without any significant post-operative complication.
腰麻-硬膜外联合麻醉（CSE）越来越多地用于有效的术后镇痛。本研究旨在评估硬膜外可乐定对妇科手术腰麻特征的影响。
这是一项前瞻性随机、双盲、对照研究，纳入60例美国麻醉医师协会身体状况I级和II级且接受妇科手术的患者，随机分为可乐定（C）组和生理盐水（S）组，每组30例。所有患者均接受CSE麻醉。在蛛网膜下腔阻滞（SAB）前10分钟，C组接受将150μg可乐定稀释至5ml生理盐水中的溶液，S组接受硬膜外注射生理盐水。两组在硬膜外注射后均鞘内注射重比重布比卡因（15mg）。观察感觉和运动阻滞特征、镇痛、镇静及血流动力学情况。采用适当的检验进行统计分析。
硬膜外给予可乐定起效更快（C组为37.83±8.58秒，S组为50.33±8.80秒，P = 0.001），感觉阻滞持续时间延长（C组为241.17±18.65分钟，S组为150.33±19.16分钟，P = 0.001）。感觉阻滞的两节段消退时间C组为193.67±19.82分钟，S组为109.33±18.56分钟（P < 0.001）。镇痛持续时间C组为299.00±43.38分钟，S组为152.50±21.04分钟（P < 0.001）。两组间血流动力学和镇静评分相当。
在SAB前10分钟硬膜外给予可乐定可使运动阻滞和镇痛起效早且持续时间延长，且无任何明显的术后并发症。
