Mercier F J, Dounas M, Bouaziz H, Des Mesnards-Smaja V, Foiret C, Vestermann M N, Fischler M, Benhamou D
Département d'Anesthésie-Réanimation, Hôpital Antoine Béclère, Clamart, France.
Anesthesiology. 1998 Sep;89(3):594-601. doi: 10.1097/00000542-199809000-00007.
Preliminary studies have suggested that the addition of clonidine to intrathecal sufentanil prolongs analgesia without producing motor blockade.
Fifty-three nulliparous women in painful labor were included in this prospective, randomized, double-blinded study. Parturients at 2- to 5-cm cervical dilation received either 5 microg sufentanil plus 30 microg clonidine or 5 microg sufentanil intrathecally, followed by 5 mg bupivacaine epidurally. The primary outcome was time until first request for additional analgesia. Visual analog pain scores, sensory changes, blood pressure, heart rate, ephedrine requirements, motor blockade, sedation, pruritus, and nausea were also recorded.
All parturients but one had effective analgesia in both groups, with similar sensory levels never exceeding T2. The duration (mean +/- SD) of analgesia was longer in the sufentanil-clonidine group: 125+/-46 versus 97+/-30 min (P = 0.007). The incidence of hypotension and the ephedrine requirements (median with range) were higher in the sufentanil-clonidine group: 63% versus 12% (P < 0.001) and 7.5 mg [range, 0-25.5 mg] versus 0 mg [range, 0-6 mg] (P < 0.0001). The incidence of fetal heart rate abnormalities during the first 30 min after intrathecal injection was similar in both groups (17% vs. 19%). No parturient had motor blockade.
The addition of 30 microg clonidine to 5 microg intrathecal sufentanil extended the duration of labor analgesia without producing motor blockade. However, as previously reported with 100-200 microg clonidine, the incidence of hypotension and the ephedrine requirements were also increased, even when 30 microg clonidine only was added.
初步研究表明，鞘内注射舒芬太尼时加用可乐定可延长镇痛时间且不产生运动阻滞。
本前瞻性、随机、双盲研究纳入了53例处于疼痛分娩期的未产妇。宫颈扩张2至5厘米的产妇鞘内注射5微克舒芬太尼加30微克可乐定或5微克舒芬太尼，随后硬膜外注射5毫克布比卡因。主要结局指标为至首次要求追加镇痛的时间。还记录了视觉模拟疼痛评分、感觉变化、血压、心率、麻黄碱用量、运动阻滞、镇静、瘙痒和恶心情况。
两组中除1例产妇外其他所有产妇均获得有效镇痛，感觉平面相似，均未超过T2。舒芬太尼-可乐定组的镇痛持续时间（均值±标准差）更长：125±46分钟对97±30分钟（P = 0.007）。舒芬太尼-可乐定组低血压发生率和麻黄碱用量（中位数及范围）更高：63%对12%（P < 0.001）以及7.5毫克[范围，0至25.5毫克]对0毫克[范围，0至6毫克]（P < 0.0001）。鞘内注射后最初30分钟内胎儿心率异常发生率在两组中相似（17%对19%）。无产妇出现运动阻滞。
鞘内注射5微克舒芬太尼时加用30微克可乐定可延长分娩镇痛时间且不产生运动阻滞。然而，正如之前100至200微克可乐定的报道一样，即使仅加用30微克可乐定，低血压发生率和麻黄碱用量也会增加。
