Gupta Divya, Mangwana Pramod, Sharma Roma, Wadhwa Bharti, Kerai Sukhyanti
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College, Delhi, India.
Department of Anaesthesiology, Mata Chanan Devi Hospital, Delhi, India.
Turk J Anaesthesiol Reanim. 2021 Apr;49(2):118-123. doi: 10.5152/TJAR.2020.55938. Epub 2020 Nov 30.
This prospective randomised double-blind study was conducted to compare the effect of intravenous (IV) with intraperitoneal (IP) administration of clonidine with respect to analgesic efficacy and side effects.
A total of 60 American Society of Anaesthesiologists (ASA) physical status class I and II patients, aged 35-60 years, undergoing total abdominal hysterectomy, were randomly divided into 2 groups. Standard general anaesthesia technique was used. All the patients in group IV received 3 μg kg of IV clonidine after resection of the uterus along with 0.25% bupivacaine (20 mL intraperitoneally and 10 mL as wound infiltration), whereas patients in group IP received 10 mL of normal saline intravenously and 3 μg kg of clonidine mixed with 0.25% bupivacaine (20 mL intraperitoneally and 10 mL as wound infiltration). Postoperative analgesia was provided with IV diclofenac every 8 hours and IV fentanyl (1 μg kg) on demand. Pain at rest, opioid consumption, level of sedation and severity of nausea were recorded for 24 hours. The heart rate (HR) and blood pressure (BP) were recorded at an interval of 15 minutes for 2 hours followed by routine hourly monitoring.
Both the groups were found to be similar with respect to demography and ASA physical status. The maximum pain was felt at 6 hours in both the groups. The mean visual analogue scale score at 6 hours (p=0.47) was comparable. However, patients in group IV had significantly higher sedation (p<0.001) and nausea (p=0.013) scores on arrival at post-anaesthesia care unit along with a significant reduction in HR (p=0.001) and BP (p=0001) for the first 2 hours postoperatively.
Although IP clonidine is comparable with IV clonidine with respect to postoperative pain scores and supplementary opioid requirement, the side effects are significantly less with IP clonidine.
开展这项前瞻性随机双盲研究，以比较静脉注射（IV）与腹腔内注射（IP）可乐定的镇痛效果及副作用。
选取60例年龄在35至60岁、美国麻醉医师协会（ASA）身体状况分级为I级和II级、行全腹子宫切除术的患者，随机分为2组。采用标准全身麻醉技术。IV组所有患者在子宫切除术后接受3μg/kg静脉注射可乐定，同时给予0.25%布比卡因（20mL腹腔内注射，10mL用于伤口浸润），而IP组患者静脉注射10mL生理盐水，以及3μg/kg可乐定与0.25%布比卡因混合液（20mL腹腔内注射，10mL用于伤口浸润）。术后每8小时静脉注射双氯芬酸，并按需静脉注射芬太尼（1μg/kg）进行镇痛。记录24小时静息时疼痛、阿片类药物用量、镇静水平和恶心严重程度。术后2小时内每隔15分钟记录心率（HR）和血压（BP），随后进行常规每小时监测。
两组在人口统计学和ASA身体状况方面相似。两组均在术后6小时疼痛最为剧烈。6小时时的平均视觉模拟评分（p = 0.47）具有可比性。然而，IV组患者在进入麻醉后护理单元时镇静评分显著更高（p < 0.001）、恶心评分显著更高（p = 0.013），且术后前2小时HR（p = 0.001）和BP（p = 0.001）显著降低。
尽管IP可乐定与IV可乐定在术后疼痛评分和补充阿片类药物需求方面相当，但IP可乐定的副作用明显更少。
