Jamali S, Monin S, Begon C, Dubousset A M, Ecoffey C
Department of Anesthesiology and Intensive Care, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France.
Anesth Analg. 1994 Apr;78(4):663-6. doi: 10.1213/00000539-199404000-00008.
Extradural clonidine produces analgesia in adults. To assess its efficacy in children, we randomized 45 pediatric patients aged 1-7 yr presenting for a subumbilical surgery into three groups of 15 each. After halothane and N2O/O2 induction, and with a double-blind protocol, caudal anesthesia was performed with 1 mL/kg of 0.25% bupivacaine. Epinephrine 1/200,000 was added in one group (EG), 1 microgram/kg of clonidine in another group (CG), and no additional medication in the last group (BG). Postoperative analgesia was evaluated using the Broadman "objective pain/discomfort scale" (OPS) at 1-h intervals until the first analgesic administration. There were no differences among the groups in age, weight, duration of surgery, baseline systolic arterial pressure, and heart rate. The mean (+/- SD) duration of analgesia was longer in the CG (987 +/- 573 min) than in the EG (377 +/- 341 min) and BG (460 +/- 439 min); P < 0.01. The maximal OPS scores were lower in the CG than in the EG and BG (2.3 +/- 1.6 vs 3.4 +/- 1.4 and 3.4 +/- 1.8, respectively; P < 0.05). More patients in the CG (n = 7) than in the EG (n = 1) and BG (n = 2) required no postoperative analgesia; P < 0.05. No differences were found among the groups for the minimal respiratory rate and minimal Spo2 values in the postoperative phase, and there were no differences among the groups for heart rate and systolic arterial pressure during the 3 h after caudal anesthesia. We conclude that the duration of postoperative analgesia with caudal bupivacaine was significantly increased by the addition of 1 microgram/kg of clonidine.
硬膜外可乐定可使成人产生镇痛作用。为评估其在儿童中的疗效，我们将45例年龄在1至7岁、拟行脐下手术的儿科患者随机分为三组，每组15例。在氟烷和N2O/O2诱导后，采用双盲方案，用1 mL/kg的0.25%布比卡因进行骶管麻醉。一组（EG）加入1/200,000肾上腺素，另一组（CG）加入1微克/千克可乐定，最后一组（BG）不添加其他药物。术后使用布罗德曼“客观疼痛/不适量表”（OPS）每隔1小时评估一次镇痛效果，直至首次给予镇痛药。三组在年龄、体重、手术时间、基础收缩动脉压和心率方面无差异。CG组的平均（±标准差）镇痛持续时间（987±573分钟）长于EG组（377±341分钟）和BG组（460±439分钟）；P<0.01。CG组的最大OPS评分低于EG组和BG组（分别为2.3±1.6 vs 3.4±1.4和3.4±1.8；P<0.05）。CG组（n = 7）中无需术后镇痛的患者比EG组（n = 1）和BG组（n = 2）更多；P<0.05。术后阶段三组的最低呼吸频率和最低血氧饱和度值无差异，骶管麻醉后3小时内三组的心率和收缩动脉压也无差异。我们得出结论，添加1微克/千克可乐定可显著延长骶管布比卡因的术后镇痛持续时间。
