Gibbs Anna, Kim Stephani S, Heydinger Grant, Veneziano Giorgio, Tobias Joseph
The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
J Pain Res. 2020 Oct 30;13:2749-2755. doi: 10.2147/JPR.S281484. eCollection 2020.
In neonates and infants, epidural analgesia has gained popularity as a means of providing postoperative analgesia, limiting opioid-related adverse effects and improving the postoperative course. In addition to a local anesthetic agent, adjunctive agents may be added to further augment analgesia. Clonidine is an α-adrenergic agonist that is frequently added to single-shot caudal analgesia, but there are limited data regarding its use in a continuous epidural infusion, especially in patients ≤12 months of age.
We retrospectively reviewed the hospital records of neonates and infants who received postoperative epidural infusions with 2-chloroprocaine, and clonidine was identified over a 4-year period.
The study cohort included 52 neonates and infants ranging in age from 0 to 12 months and in weight from 2.1 to 10.1 kilograms. The catheters were dosed with either 1.5% 2-chloroprocaine (n=47) or 3% 2-chloroprocaine (n=5) with clonidine (median concentration 0.2 µg/mL) infused at a median rate of 0.72 mL/kg/hour. Pain scores were uniformly ≤3 at all evaluation points during the first 72 postoperative hours with a limited need for supplemental systemic opioids. No serious adverse effects were noted.
With the recognized limitations of a retrospective study, these preliminary data demonstrate the safety of adding clonidine to an epidural infusion of 2-chloroprocaine in neonates and infants less than 12 months of age. Future studies are needed to determine its analgesic efficacy compared to 2-chloroprocaine alone and the optimal clonidine concentration for postoperative epidural infusions.
在新生儿和婴儿中，硬膜外镇痛作为一种提供术后镇痛、限制阿片类药物相关不良反应并改善术后病程的方法已越来越受欢迎。除了局部麻醉剂外，还可添加辅助药物以进一步增强镇痛效果。可乐定是一种α-肾上腺素能激动剂，常用于单次骶管镇痛，但关于其在连续硬膜外输注中的应用数据有限，尤其是在12个月及以下的患者中。
我们回顾性分析了4年间接受2-氯普鲁卡因术后硬膜外输注的新生儿和婴儿的医院记录，并确定了使用可乐定的情况。
研究队列包括52例年龄在0至12个月、体重在2.1至10.1千克之间的新生儿和婴儿。导管中注入1.5%的2-氯普鲁卡因（n = 47）或3%的2-氯普鲁卡因（n = 5），并以0.72 mL/kg/小时的中位速率输注可乐定（中位浓度0.2 µg/mL）。术后72小时内所有评估点的疼痛评分均≤3，对补充全身性阿片类药物的需求有限。未观察到严重不良反应。
鉴于回顾性研究存在公认的局限性，这些初步数据表明，在12个月以下的新生儿和婴儿中，将可乐定添加到2-氯普鲁卡因硬膜外输注中是安全的。未来需要开展研究，以确定与单独使用2-氯普鲁卡因相比其镇痛效果，以及术后硬膜外输注的最佳可乐定浓度。
