Singh Raj Bahadur, Shekhar Saurav, De Ranjeet Rana, Singh Siddharth, Singh Ritu, Singh Akrity
Department of Anaesthesia (Trauma and Emergency), Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Department of Medicine (Trauma and Emergency), Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Anesth Essays Res. 2022 Jan-Mar;16(1):104-108. doi: 10.4103/aer.aer_31_22. Epub 2022 Jun 29.
Spinal subarachnoid block (SAB) is the first choice anesthesia in lower abdominal and lower limb surgeries. It produces a varying degree of sensory analgesia, motor blockade, and sympathetic blockade depending on the dose, concentration, and volume of the local anesthetic given. This study was undertaken to assess the degree of sensory and motor block with 150 μg of oral versus intramuscular clonidine as an adjuvant to bupivacaine for spinal anesthesia.
To compare the efficacy of oral versus intramuscular clonidine as an adjuvant to bupivacaine for the prolongation of sensory and motor block in patients undergoing lower abdominal and lower limb surgeries under SAB.
After institutional ethical clearance, 90 patients were randomized into three groups scheduled for lower abdominal and lower limb surgeries under spinal anesthesia. • Group O: Bupivacaine 0.5% (heavy) 3.0 mL and oral clonidine 150 μg 1 h before spinal anesthesia. • Group I: Bupivacaine 0.5% (heavy) 3.0 mL and intramuscular clonidine 150 μg 1 h before spinal anesthesia. • Group C: Control group - 3 mL bupivacaine 0.5% (heavy) alone.
The onset of sensory block in Group O was 4.9 ± 0.52 min, whereas in Group I, it was 4.6 ± 0.42 min than Group C (5.1 ± 0.60). Onset of motor block was also significantly lower in Group O and Group I (3.9 ± 0.53 and 3.7 ± 0.42 min) than in Group C (4.4 ± 0.6 min) which was a control group. There was also a significant difference in the duration of the sensory block between Group O (206.4 ± 9.2 min), Group I (219 ± 8.6 min), and Group C (184.3 ± 9.1 min). The duration of motor block was significantly higher in Group O (183.6 ± 8.2 min) and Group I (197.8 ± 9.6 min) when compared to Group C (162.8 ± 8.9 min). The timing of rescue analgesia in Group O was 222.4 ± 11.7 min, whereas in Group I, it was 243.46 ± 10.9.
On the basis of finding of our study, we conclude that the use of clonidine as a premedication at a dose of 150 μg significantly increased the duration of sensory block, motor block, and duration of analgesia and shortened the time of onset of sensory and motor blockade.
蛛网膜下腔阻滞（SAB）是下腹部和下肢手术的首选麻醉方法。根据所给局部麻醉药的剂量、浓度和容量，它会产生不同程度的感觉镇痛、运动阻滞和交感神经阻滞。本研究旨在评估口服与肌内注射150μg可乐定作为布比卡因蛛网膜下腔麻醉辅助用药时的感觉和运动阻滞程度。
比较口服与肌内注射可乐定作为布比卡因辅助用药，在接受蛛网膜下腔阻滞的下腹部和下肢手术患者中延长感觉和运动阻滞的效果。
经机构伦理批准后，90例计划接受蛛网膜下腔麻醉下腹部和下肢手术的患者被随机分为三组。• O组：蛛网膜下腔麻醉前1小时给予0.5%（重比重）布比卡因3.0 mL和口服可乐定150μg。• I组：蛛网膜下腔麻醉前1小时给予0.5%（重比重）布比卡因3.0 mL和肌内注射可乐定150μg。• C组：对照组——仅给予3 mL 0.5%（重比重）布比卡因。
O组感觉阻滞起效时间为4.9±0.52分钟，而I组为4.6±0.42分钟，均短于C组（5.1±0.60分钟）。O组和I组的运动阻滞起效时间（分别为3.9±0.53分钟和3.7±0.42分钟）也显著低于对照组C组（4.4±0.6分钟）。O组（206.4±9.2分钟）、I组（219±8.6分钟）和C组（184.3±9.1分钟）之间的感觉阻滞持续时间也存在显著差异。与C组（162.8±8.9分钟）相比，O组（183.6±8.2分钟）和I组（197.8±9.6分钟）的运动阻滞持续时间显著更长。O组补救镇痛时间为222.4±11.7分钟，而I组为243.46±10.9分钟。
根据我们的研究结果，我们得出结论，以150μg剂量使用可乐定作为术前用药可显著延长感觉阻滞、运动阻滞和镇痛持续时间，并缩短感觉和运动阻滞的起效时间。
