Randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine
Randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine
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DOI：
10.1016/j.jclinane.2016.04.024
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发表时间：
2016-09-01
影响因子：
6.7
通讯作者：
Mota, Angela
中科院分区：
文献类型：
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作者：
Carvalho, Francisco A. E.;Tenorio, Sergio B.;Mota, Angela
研究目的：探讨鞘内吗啡与可乐定联合用药与单独使用 2 剂鞘内吗啡用于剖宫产后镇痛的效果。设计：前瞻性、双盲、随机临床试验。地点：巴西巴拉那州库里蒂巴圣克鲁斯医院产科病房（手术室和病房）。患者：该研究包括 195 名美国麻醉医师协会 I 至 III 级单例患者接受择期剖宫产的产妇。干预措施：将患者随机分为 3 组（M50、M100 和 M/C）。患者用12毫克0.5％高压布比卡因和50微克或100微克吗啡（分别为M50和M100组）或50微克吗啡和75微克可乐定（M/C组）进行鞘内麻醉。测量：随后在术后9至11小时和22至24小时评估患者的疼痛水平和副作用主要结果：各组之间的疼痛缓解质量没有差异。在所有 3 组中，第一次评估期间疼痛都更加剧烈。 M100组瘙痒、恶心较多，M/C组头晕较多；然而，这些结果在统计上并不显着。与其他组相比，接受可乐定的组颤抖的发生率显着降低。结论：在这些剂量下，将可乐定与吗啡联合使用并不能改善剖腹产后镇痛。考虑到较高剂量的吗啡会带来较多的副作用，单独鞘内注射50μg吗啡似乎是更好的镇痛选择。使用可乐定来减少术后颤抖必须与低血压、心动过缓、头晕和镇静的潜在风险相平衡。 (C) 2016 Elsevier Inc. 保留所有权利。
Study objective: To investigate the efficacy of the combination of intrathecal morphine with clonidine in comparison with 2 doses of intrathecal morphine alone for postcesarean analgesia.Design: Prospective, double-blinded, randomized clinical trial.Setting: Maternity ward of Hospital Santa Cruz, Curitiba, Parana, Brazil (operating room and ward).Patients: The study included 195 American Society of Anesthesiologist I to III singleton parturients undergoing elective cesarean section.Interventions: The patients were randomized into 3 groups (M50, M100, and M/C). Patients were anesthetized intrathecally with 12 mg of 0.5% hyperbaric bupivacaine and 50 mu g or 100 mu g morphine (groups M50 and M100, respectively) or 50 mu g morphine and 75 mu g clonidine (group M/C).Measurements: The patients were subsequently assessed for pain levels and side effects at 9 to 11 hours and 22 to 24 hours after the injection.Main results: There was no difference in the quality of pain relief among the groups. In all 3 groups, pain was more intense during the first assessment. Pruritus and nausea were more frequent in group M100, and dizziness was more frequent in group M/C; however, these results were statistically insignificant. The group receiving clonidine showed a significantly lower incidence of shivering compared with the other groups.Conclusions: At these doses, there was no benefit of associating clonidine with morphine to improve post cesarean analgesia. Considering that higher doses of morphine were associated with more side effects, 50 mu g of intrathecal morphine alone seems to be a better option for analgesia. The use of clonidine to reduce postoperative shivering must be balanced against the potential risks of hypotension, bradycardia, dizziness, and sedation. (C) 2016 Elsevier Inc. All rights reserved.