Rawat Jyoti, Shyam Radhey, Kaushal Dinesh
Department of Anaesthesiology, King George Medical University, Lucknow, Uttar Pradesh, India.
Department of Geriatric Intensive Care Unit (Anaesthesiology), King George Medical University, Lucknow, Uttar Pradesh, India.
Anesth Essays Res. 2019 Oct-Dec;13(4):620-624. doi: 10.4103/aer.AER_127_19. Epub 2019 Dec 16.
Caudal block is a simple, safe procedure with fewer side effects to provide intraoperative and postoperative analgesia in pediatric patients. Many drugs were used as an additive to local anesthetics in caudal block. All these drugs had their own side effects.
In this study, we compare the effects of tramadol and clonidine as an additive to levobupivacaine in caudal block in children undergoing perineal surgeries regarding hemodynamic changes, analgesic effects, and side effects.
This is a prospective, double-blind randomized, controlled study, conducted in Department of Paediatric Surgery, at King George's Medical University, Lucknow, Uttar Pradesh during 2017-2018.
After informed consent and ethical clearance from institutional ethics committee, King Georges Medical University, Lucknow. Total 66 patients aged 1-10 year, planned for perineal surgery were randomly allocated according to computer-generated random number, into three groups. Group I - 0.25% levobupivacaine (1 mL.kg) alone, Group II - 0.25% levobupivacaine (1 mL.kg) with tramadol 1 mL.kg, and Group III - 0.25% levobupivacaine (1 mL.kg) with clonidine 1 μg.kg. Perioperative pain was the primary outcome. Hemodynamic parameters: heart rate, mean arterial pressure, and peripheral oxygen saturation were recorded. Postoperative pain assessed by Children and Infants Postoperative Pain Scale (CHIPPS), sedation by Ramsay sedation score and requirement of rescue analgesia were recorded at predetermined time intervals.
The values were represented in number (%) and mean ± standard deviation. Comparison of quantitative variables between the study groups was done using ANOVA test and Mann-Whitney U-test. Categorical data were analyzed using Chi-square test.
Postoperative analgesic effect was significantly longer in levobupivacaine with clonidine group as compared to tramadol with levobupivacaine group and levobupivacaine alone group.
Clonidine in a dose of 1 μg.kg when added to levobupivacaine in caudal block significantly prolongs the duration of analgesia as compared to tramadol with levobupivacaine and levobupivacaine alone without any clinically significant side effects. Thus, it is better to add additive like clonidine to enhance the effect of analgesia.
骶管阻滞是一种简单、安全且副作用较少的操作，可为儿科患者提供术中及术后镇痛。许多药物被用作骶管阻滞中局部麻醉药的添加剂。所有这些药物都有其自身的副作用。
在本研究中，我们比较曲马多和可乐定作为左旋布比卡因添加剂用于会阴手术患儿骶管阻滞时，对血流动力学变化、镇痛效果及副作用的影响。
这是一项前瞻性、双盲随机对照研究，于2017 - 2018年在北方邦勒克瑙市乔治国王医学院儿外科进行。
获得勒克瑙市乔治国王医学院机构伦理委员会的知情同意和伦理批准后。总共66例年龄在1 - 10岁、计划进行会阴手术的患者，根据计算机生成的随机数随机分为三组。第一组 - 仅用0.25%左旋布比卡因（1 mL/kg），第二组 - 0.25%左旋布比卡因（1 mL/kg）加曲马多1 mL/kg，第三组 - 0.25%左旋布比卡因（1 mL/kg）加可乐定1 μg/kg。围手术期疼痛是主要观察指标。记录血流动力学参数：心率、平均动脉压和外周血氧饱和度。术后疼痛通过儿童和婴儿术后疼痛量表（CHIPPS）评估，镇静通过拉姆齐镇静评分评估，并在预定时间间隔记录急救镇痛的需求。
数值以例数（%）和均值±标准差表示。研究组间定量变量的比较采用方差分析和曼 - 惠特尼U检验。分类数据采用卡方检验进行分析。
与左旋布比卡因加曲马多组和单纯左旋布比卡因组相比，左旋布比卡因加可乐定组术后镇痛效果显著延长。
与左旋布比卡因加曲马多组和单纯左旋布比卡因组相比，骶管阻滞中左旋布比卡因加入1 μg/kg剂量的可乐定可显著延长镇痛持续时间，且无任何临床显著副作用。因此，添加可乐定等添加剂以增强镇痛效果更好。
Zotero 插件