- 期刊
Comparison of Epidural Butorphanol Plus Clonidine with Butorphanol Alone for Postoperative Pain Relief
硬脊膜外腔合併注射Butorphanol及Clonidine與單獨注射Butorphanol對術後止痛之比較
摘要
Background: Epidural butorphanol has been shown to produce effective analgesia with less side effects than that of morphine but relatively short duration. Clonidine, an α_2-adrenergic agonist, has been reported to provided pain relief by epidural administration. Furthermore, epidural clonidine has been shown to potentiate the analgesic effect of epidural morphine. The present study was undertaken to evaluate the analgesic and side effects of epidural administration (Ep) of butorphanol and clonidine. Methods: After giving their consents, 60 adult patients scheduled for abdominal surgeries were enrolled in this study. Prior to anesthesia induction, indwelling lumbar epidural catheters were placed in all patients who then received general anesthesia with inhalation anesthetic without narcotic analgesics. In the postoperative period, when the patients first complained of pain, they were divided into 2 equal groups of 30 patients each in a randomized and double blinded fashion with Group I receiving Ep butorphanol 0.5 mg and Group II receiving Ep butorphanol 0.5 mg plus clonidine 75 μg. All patients were observed for pain relief, sedation, vital signs, arterial blood gas studies and adverse effects for 12 h. Results: Onset of pain relief with epidural butorphanol began at 5 min and peaked at 20-30 min with a duration of action lasting 4-6 h. The combination of butorphanol and clonldine had numerically superior pain relief than that of butorphanol for the first 30 min but it did not attain statistical significant difference. The duration of action with the combination group was similar to that of butorphanol alone. Incidence of adverse effects were similar in both groups except that hypotension and more pronounced sedation were observed in Group II. Conclusions: Our study showed that the addition of clonidine to epidural butorphanol did not enhance its analgesic effect in any significant manner nor did it reduce the adverse effects. This combination does not seem to offer any advantage for clinical use.
並列摘要
背景：本研究的目的在探討經由硬脊膜外腔合併使用butorphanol及clonidine時，所產生之臨床術後止痛效果，硬脊膜外給予butorphanol具有相當止痛療效，雖然止痛效程比嗎啡短，但相對的副作用亦小，clonidine曾經被證實使用在硬脊膜外注射具有止痛效果，近來發現硬脊膜外給予clonidine及成癮性止痛劑，顯現clonidine具有加深成癮性止痛劑止痛效用。方法：本研究選擇六十位接受腹部手術之病患在麻醉誘導之前，先放好硬脊膜外導管，然後均施予全身麻醉，僅給吸入性麻醉劑，不給成癮性麻醉劑。術後當病人抱怨疼痛時，將他們依序分成兩組，第一組術後接受0.5 mg butorphanol，第二組接受0.5 mg butorphanol加75μg clonidine時，分別注射於硬脊膜外，所有病人均觀察其疼痛緩解，鎮靜，血壓，呼吸狀態和副作用12小時。結果：顯示第一組硬脊膜外腔給予butorphanol 5分鐘後開始產生止痛作用，而在20至30分鐘時達到高峰，並維持4至6小時。合併使用butorphanol和clonidine在開始的前30分鐘，疼痛緩解較優於單獨使用butorphanol，但並不具有統計之意義，兩組的止痛程度及作用時間皆非常相近，副作用的發生率兩組亦非常相近，惟第二組會發生低血壓及長時間昏睡作用。結論：綜合以上研究得知，硬脊膜外給予clonidine 75μg並無加強butorphanol痛效果，亦無減少副作用，此方法合併使用似乎並無助益於臨床上的使用。
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