Sharan Radhe, Verma Rajan, Dhawan Akshay, Kumar Jugal
Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):526-531. doi: 10.4103/0259-1162.180781.
Ropivacaine, a newer local anesthetic, is gaining increased acceptance due to its improved safety profile over bupivacaine and lignocaine. Analgesic adjuvants have proved to be valuable in improving the quality of anesthesia and duration of analgesia.
To compare the efficacy of clonidine and fentanyl as adjuvants to ropivacaine in spinal anesthesia in lower abdominal surgeries.
A randomized, double-blind control study was carried out in 100 patients who were randomly divided into two groups. Ropivacaine-clonidine group (RC) received 30 μg of clonidine with 18.75 mg of 0.75% isobaric ropivacaine, Ropivacaine-fentanyl group (RF) received 25 μg of fentanyl with 18.75 mg of 0.75% isobaric ropivacaine intrathecally. The onset and duration of sensory and motor block, hemodynamic parameters, quality of surgical analgesia, total analgesia time, sedation score, and side effects were statistically analyzed using SPSS statistical package, paired and unpaired -tests and Chi-square test.
The duration of sensory block in RC (240.00 ± 20.99), RF (196.80 ± 18.34), and motor block in RC (192.20 ± 17.36), RF (139.20 ± 17.93) outlasted the duration of surgery. In clonidine group, there was significant prolongation of sensory block, motor block and the total analgesia time. Hypotension and bradycardia occurred more commonly in RC group, whereas pruritus was more in RF group.
Ropivacaine when combined with either clonidine or fentanyl provided an adequate subarachnoid block for lower abdominal surgeries. As an adjuvant, clonidine has advantage over fentanyl as it increased the duration of the subarachnoid block and the postoperative analgesia.
罗哌卡因是一种新型局部麻醉药，因其相较于布比卡因和利多卡因具有更好的安全性，正越来越被广泛接受。镇痛辅助剂已被证明在提高麻醉质量和延长镇痛时间方面具有重要价值。
比较可乐定和芬太尼作为罗哌卡因辅助剂用于下腹部手术脊髓麻醉的效果。
对100例患者进行随机双盲对照研究，将其随机分为两组。罗哌卡因 - 可乐定组（RC）接受30μg可乐定与18.75mg 0.75%等比重罗哌卡因，罗哌卡因 - 芬太尼组（RF）接受25μg芬太尼与18.75mg 0.75%等比重罗哌卡因鞘内注射。使用SPSS统计软件包对感觉和运动阻滞的起效时间和持续时间、血流动力学参数、手术镇痛质量、总镇痛时间、镇静评分及副作用进行统计学分析，采用配对和非配对t检验以及卡方检验。
RC组感觉阻滞持续时间（240.00±20.99）、RF组感觉阻滞持续时间（196.80±18.34），以及RC组运动阻滞持续时间（192.20±17.36）、RF组运动阻滞持续时间（139.20±17.93）均超过手术时间。在可乐定组，感觉阻滞、运动阻滞及总镇痛时间均有显著延长。低血压和心动过缓在RC组更常见，而瘙痒在RF组更常见。
罗哌卡因与可乐定或芬太尼联合使用可为下腹部手术提供充分的蛛网膜下腔阻滞。作为辅助剂，可乐定比芬太尼更具优势，因为它延长了蛛网膜下腔阻滞和术后镇痛的持续时间。
