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首页> 外文期刊>European journal of anaesthesiology >Effects of a continuous low-dose clonidine epidural regimen on pain, satisfaction and adverse events during labour: a randomized, double-blind, placebo-controlled trial.
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Effects of a continuous low-dose clonidine epidural regimen on pain, satisfaction and adverse events during labour: a randomized, double-blind, placebo-controlled trial.

机译：连续小剂量可乐定硬膜外硬膜外疗法对分娩过程中疼痛，满意度和不良事件的影响：一项随机，双盲，安慰剂对照试验。

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BACKGROUND AND OBJECTIVE: Epidural clonidine has been proposed as an adjunct for anaesthetic mixtures during labour. Administered as a bolus, clonidine may have side effects such as sedation and hypotension; its continuous infusion could be attractive in this respect. We, therefore, conducted a randomized, double-blind trial using patient-controlled epidural analgesia with a background infusion using a low dose of clonidine during labour. METHODS: A total of 128 healthy parturients in active labour received a patient-controlled epidural analgesia solution of 0.0625% levobupivacaine and sufentanil 0.25 microg ml(-1) with or without clonidine 2 microg ml(-1). Ninety-five parturients were analysed. The pain score over time was evaluated as well as drug volume utilization; supplementation bolus and side effects were recorded. The primary endpoint was maternal satisfaction [ClinicalTrials.gov Identifier (NCT00437996)]. RESULTS: Three patients in the control group failed to achieve satisfactory epidural analgesia owing to a technical issue. Although the primary endpoint was not statistically significant, analgesia was more pronounced and obtained earlier in the clonidine group. The area under the curve for the visual analogue pain score was significantly lower in the clonidine group. In this group, hourly doses of levobupivacaine and sufentanil were reduced (13.9 +/- 4.3 vs. 16.3 ml +/- 4.0; P = 0.005) as well as rescue supplementation and pruritus incidence (18 vs. 46%; P = 0.004). Maternal blood pressure was significantly lower, over time, in the clonidine group but remained within the normal range. Sedation was similar in both groups (4.3 vs. 2.0%; not significant). CONCLUSION: The addition of clonidine to epidural levobupivacaine and sufentanil for patient-controlled epidural analgesia in labour improved analgesia, reduced the supplementation rate and reduced pruritus without improvement in maternal satisfaction. Blood pressure was significantly lower in the clonidine group over time but without clinical consequence.
机译：背景与目的：硬膜外可乐定已被提议作为分娩期间麻醉混合物的辅助剂。以大剂量给药时，可乐定可能会产生诸如镇静和低血压等副作用。在这方面，其连续输注可能是有吸引力的。因此，我们进行了一项随机，双盲试验，使用了患者控制的硬膜外镇痛，并在分娩时使用了低剂量的可乐定进行背景输注。方法：总共128名从事积极分娩的健康产妇接受了患者控制的硬膜外镇痛药溶液，该溶液为0.0625％左旋布比卡因和舒芬太尼0.25 microg ml（-1），含或不含可乐定2 microg ml（-1）。分析了九十五个产妇。评估随着时间的疼痛评分以及药物用量。记录补充推注和副作用。主要终点是产妇满意度[ClinicalTrials.gov标识符（NCT00437996）]。结果：由于技术问题，对照组中的三名患者未能获得满意的硬膜外镇痛效果。尽管主要终点在统计学上不显着，但可乐定组的镇痛作用更为明显，且较早获得。在可乐定组中，视觉类似物疼痛评分的曲线下面积明显较低。在该组中，左旋布比卡因和舒芬太尼的每小时剂量减少（13.9 +/- 4.3对16.3 ml +/- 4.0; P = 0.005）以及急救补充和瘙痒发生率（18对46％; P = 0.004） 。随着时间的推移，可乐定组的孕妇血压明显降低，但仍保持在正常范围内。两组的镇静作用相似（4.3比2.0％;不显着）。结论：硬膜外左旋布比卡因和舒芬太尼中添加可乐定可控制分娩时患者的硬膜外镇痛效果，改善了镇痛效果，降低了补充率，减少了瘙痒，但并未改善母体满意度。随着时间的推移，可乐定组的血压明显降低，但无临床后果。

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