Claes B, Soetens M, Van Zundert A, Datta S
Department of Anesthesiology and Intensive Care, O.L.V. Middelares Hospital, Deurne, Belgium.
Reg Anesth Pain Med. 1998 Nov-Dec;23(6):540-7. doi: 10.1016/s1098-7339(98)90078-5.
A double-blind study was conducted to assess the efficacy and the side effects of a low dose of clonidine added to an epidural injection of bupivacaine and epinephrine, with or without sufentanil.
One hundred healthy parturients (ASA 1) were randomly allocated into four groups according to the type of epidural analgesia administered. The bupivacaine/epinephrine (BE) group received a 10-mL standard injection of bupivacaine (B) 1.25 mg/mL and epinephrine (E) 1.25 microg/mL. In the bupivacaine/epinephrine/sufentanil (BES) group, 7.5 microg sufentanil (S) was added to the BE mixture. For the bupivacaine/ epinephrine/clonidine (BEC) group, 50 microg clonidine (C) was added to the BE mixture, whereas for the bupivacaine/epinephrine/sufentanil/clonidine (BESC) group, both sufentanil and clonidine were added to BE. Fetal heart rate was monitored by continuous cardiotocography. Duration of analgesia, method of delivery, and neonatal outcome (measured using APGAR score, peripheral oxygen saturation, and neurologic adaptive capacity score) and side effects of clonidine were observed. The parturients were routinely asked for their global appreciation of the epidural analgesia technique by visual analog score, 2 hours postpartum.
The overall quality and duration of analgesia were superior in the BESC group compared with the other groups, as was the global appreciation by the parturient. The frequency of side effects in the clonidine groups was comparable, with the exception of hypotension and sedation. Hypotension was easily treated by fluids or ephedrine and caused no fetal distress. The level of sedation was mild, and all parturients aroused immediately after verbal commands.
The addition of a low dose of clonidine to an epidural injection of bupivacaine with epinephrine and sufentanil provides better analgesia during labor, while keeping the side effects minimal and of minor clinical importance.
开展一项双盲研究，以评估在布比卡因和肾上腺素硬膜外注射中添加低剂量可乐定（无论是否添加舒芬太尼）的疗效及副作用。
100名健康产妇（ASA 1级）根据所施行的硬膜外镇痛类型被随机分为四组。布比卡因/肾上腺素（BE）组接受10毫升标准注射，其中含1.25毫克/毫升布比卡因（B）和1.25微克/毫升肾上腺素（E）。在布比卡因/肾上腺素/舒芬太尼（BES）组中，在BE混合液中添加7.5微克舒芬太尼（S）。对于布比卡因/肾上腺素/可乐定（BEC）组，在BE混合液中添加50微克可乐定（C），而对于布比卡因/肾上腺素/舒芬太尼/可乐定（BESC）组，则在BE中同时添加舒芬太尼和可乐定。通过连续胎心监护仪监测胎儿心率。观察镇痛持续时间、分娩方式、新生儿结局（使用阿氏评分、外周血氧饱和度和神经适应性能力评分进行测量）以及可乐定的副作用。在产后2小时，常规通过视觉模拟评分法询问产妇对硬膜外镇痛技术的总体评价。
与其他组相比，BESC组的镇痛总体质量和持续时间更优，产妇的总体评价也是如此。可乐定组的副作用发生率相当，但低血压和镇静除外。低血压通过补液或麻黄碱易于治疗，且未引起胎儿窘迫。镇静程度较轻，所有产妇在言语指令后立即苏醒。
在布比卡因与肾上腺素和舒芬太尼的硬膜外注射中添加低剂量可乐定可在分娩期间提供更好的镇痛效果，同时使副作用最小化且临床重要性较小。
