Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children
Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children
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DOI：
10.1093/bja/aep159
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发表时间：
2009-08-01
影响因子：
9.8
通讯作者：
Boulis, S. R.
中科院分区：
文献类型：
--
作者：
El-Hennawy, A. M.;Abd-Elwahab, A. M.;Boulis, S. R.
骶管阻滞是儿科镇痛的常用技术，但缺点是单次注射后作用持续时间短。尾部右美托咪定和可乐定可提供显著的镇痛获益。比较右美托咪定和可乐定在小儿下腹部手术布比卡因中的镇痛效果和不良反应。在七氟烷氧气麻醉后，每例患者接受单次尾部剂量的0.25%布比卡因（1 ml kg（-1））联合右美托咪定2 μ g kg（-1）溶于1 ml生理盐水，可乐定2 μ g kg（-1）溶于1 ml生理盐水，或根据分组分配相应体积的生理盐水。监测血液动力学变量、潮气末七氟烷和苏醒时间。在前24小时内对术后镇痛、镇痛药的使用和副作用进行评估。在布比卡因尾部添加右美托咪定或可乐定显著延长了镇痛时间[中位数（95%置信区间，CI）：分别为16（14-18）和12（3-21）h]比单独使用布比卡因[中位数（95% CI）：5（4-6）h]，P < 0.001。然而，右美托咪定和可乐定之间的镇痛时间无统计学显著差异（P=0.796）。没有观察到显着差异，在发生率的血流动力学变化或副作用。此外，右美托咪定或可乐定，尾部布比卡因显着促进镇痛在儿童接受下腹部手术，右美托咪定没有显着优势可乐定，并没有增加副作用的发生率。
Caudal block is a common technique for paediatric analgesia but with the disadvantage of short duration of action after single injection. Caudal dexmedetomidine and clonidine could offer significant analgesic benefits. We compared the analgesic effects and side-effects of dexmedetomidine and clonidine added to bupivacaine in paediatric patients undergoing lower abdominal surgeries.Sixty patients (6 months to 6 yr) were evenly and randomly assigned into three groups in a double-blinded manner. After sevoflurane in oxygen anaesthesia, each patient received a single caudal dose of bupivacaine 0.25% (1 ml kg(-1)) combined with either dexmedetomidine 2 mu g kg(-1) in normal saline 1 ml, clonidine 2 mu g kg(-1) in normal saline 1 ml, or corresponding volume of normal saline according to group assignment. Haemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, use of analgesics, and side-effects were assessed during the first 24 h.Addition of dexmedetomidine or clonidine to caudal bupivacaine significantly promoted analgesia time [median (95% confidence interval, CI): 16 (14-18) and 12 (3-21) h, respectively] than the use of bupivacaine alone [median (95% CI): 5 (4-6) h] with P < 0.001. However, there was no statistically significant difference between dexmedetomidine and clonidine as regards the analgesia time (P=0.796). No significant difference was observed in incidence of haemodynamic changes or side-effects.Addition of dexmedetomidine or clonidine to caudal bupivacaine significantly promoted analgesia in children undergoing lower abdominal surgeries with no significant advantage of dexmedetomidine over clonidine and without an increase in incidence of side-effects.