可乐定作为罗哌卡因的神经周围辅助用药，在控制全身效应时并不延长感觉阻滞的持续时间：一项针对健康志愿者的配对、双盲、随机试验。

Clonidine used as a perineural adjuvant to ropivacaine, does not prolong the duration of sensory block when controlling for systemic effects: A paired, blinded, randomized trial in healthy volunteers.

作者信息

Andersen Jakob Hessel, Jaeger Pia, Sonne Tobias Laier, Dahl Jørgen Berg, Mathiesen Ole, Grevstad Ulrik

机构信息

Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark.

Department of Anaesthesiology, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen East, Denmark.

出版信息

PLoS One. 2017 Sep 7;12(9):e0181351. doi: 10.1371/journal.pone.0181351. eCollection 2017.

DOI:10.1371/journal.pone.0181351

PMID:28880902

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5589088/

Abstract

BACKGROUND

Clonidine used as an adjuvant to ropivacaine have been shown to prolong the duration of peripheral nerve blocks. The mechanism of action remains unclear. We hypothesized, that clonidine used as an adjuvant to ropivacaine extends the duration of an adductor canal block (ACB) by a peripheral mechanism, compared to ropivacaine alone when controlling for systemic effects.

METHODS

We conducted a paired, blinded, randomized trial in healthy volunteers. Participants received bilateral ACBs containing 20 ml ropivacaine 0.5% + 1 ml clonidine 150μg/ml in one leg and 20 ml ropivacaine 0.5% + 1 ml saline in the other leg. The primary outcome measure was duration of sensory block assessed by temperature sensation (alcohol swab). Secondary outcome measures were duration of sensory block assessed by: pinprick, maximum pain during tonic heat stimulation, warmth detection threshold and heat pain detection threshold.

RESULTS

We enrolled 21 volunteers and all completed the trial. There was no difference in duration of sensory block assessed with an alcohol swab: Mean duration in the leg receiving ropivacaine + clonidine was 19.4h (SD 2.7) compared to 19.3h (SD 2.4) in the leg receiving ropivacaine + placebo with a mean difference of 0.1h (95% CI: -1.0 to 1.3), P = 0.83. No differences in block duration were detected when assessed by: Pinprick, mean difference 0.0 h (95% CI: -1.3 to 1.3), maximum pain during tonic heat stimulation, mean difference -0.7 h (95% CI: -2.1 to 0.8), warmth detection threshold, mean difference -0.1 h (95% CI: -1.8 to 1.6) or heat pain detection threshold, mean difference -0.2 h (95% CI: -1.7 to 1.4).

CONCLUSIONS

Administering clonidine perineurally as an adjuvant to ropivacaine in an ACB did not prolong the duration of sensory block in a setup controlling for systemic effects of clonidine.

摘要

背景

已证实可乐定作为罗哌卡因的辅助用药可延长周围神经阻滞的持续时间。其作用机制尚不清楚。我们推测，在控制全身效应的情况下，与单独使用罗哌卡因相比，可乐定作为罗哌卡因的辅助用药通过外周机制延长了内收肌管阻滞（ACB）的持续时间。

方法

我们在健康志愿者中进行了一项配对、双盲、随机试验。参与者一侧下肢接受含有20 ml 0.5%罗哌卡因 + 1 ml 150μg/ml可乐定的双侧ACB，另一侧下肢接受20 ml 0.5%罗哌卡因 + 1 ml生理盐水。主要结局指标是通过温度感觉（酒精擦拭）评估的感觉阻滞持续时间。次要结局指标是通过以下方式评估的感觉阻滞持续时间：针刺、强直热刺激期间的最大疼痛、温热感觉阈值和热痛觉检测阈值。

结果

我们招募了21名志愿者，所有志愿者均完成了试验。用酒精擦拭评估的感觉阻滞持续时间没有差异：接受罗哌卡因 + 可乐定的下肢平均持续时间为19.4小时（标准差2.7），而接受罗哌卡因 + 安慰剂的下肢平均持续时间为19.3小时（标准差2.4），平均差异为0.1小时（95%置信区间：-1.0至1.3），P = 0.83。通过以下方式评估时未检测到阻滞持续时间的差异：针刺，平均差异0.0小时（95%置信区间：-1.3至1.3）；强直热刺激期间的最大疼痛，平均差异-0.7小时（95%置信区间：-2.1至0.8）；温热感觉阈值，平均差异-0.1小时（95%置信区间：-1.8至1.6）；或热痛觉检测阈值，平均差异-0.2小时（95%置信区间：-1.7至1.4）。