Abstract
Purpose: To evaluate the effect of adding clonidine to ropivacaine, for axillary brachial plexus blockade, on the onset and duration of sensory and motor block and duration of analgesia.
Methods: In a prospective randomised double blind placebo controlled study axillary brachial plexus blockade was performed in 50 patients using 40 ml ropivacaine 0.75%. Group (A) had 150µg donidine and Group (B) 1 ml normal saline added to the local anesthetic. Sensory function was tested using pinprick (sharp sensation, blunt sensation or no sensation) and temperature with an ice cube compared with the opposite arm, (cold/not cold). Motor function was assessed using a modified Bromage scale. Postoperative analgesia was standardised. Onset and duration of sensory and motor blockade, duration of analgesia, postoperative pain score, and analgesic requirement were compared.
Results: The clonidine patients showed an increase in duration of sensory loss from 489 min to 628 min with a mean difference of 138 min (95% confidence interval of 90 to 187 min), motor blockade from 552 min to 721 min with a mean difference of 170 min (95% confidence interval of 117 to 222 min), and analgesia from 587 min to 828 min with mean difference of 241 min (95% confidence interval of 188 to 294 min). There was no difference in onset time. No side effects were noted.
Conclusion: The addition of 150µg of clonidine to ropivacaine, for brachial plexus blockade, prolongs motor and sensory block and analgesia, without an increased incidence of side effects.
Résumé
Objectif: Évaluer l’effet d’un ajout de clonidine à la ropivacaïne, pour le blocage du plexus brachial axillaire, sur le délai d’installation et la durée du bloc sensitif et moteur et sur la durée de l’analgésie.
Méthode: Il s’agit d’une étude prospective, randomisée et à double insu contre placebo. Un blocage du plexus brachial axillaire a été réalisé chez 50 patients en utilisant 40 ml de ropivacaïne à 0,75%. On a ajouté à l’anesthésique local, 150µg de clonidine pour les patients du groupe A et 1 ml de solution salée pour ceux du grupe B. La fonction sensitive a été testée par piqûre d’épingle (sensation vive, légère sensation ou insensibilité) et la température par un cube de glace posé en alternance sur les deux bras (froid, non froid). La fonction motrice a été évaluée avec une étchelle de Bromage modifiée. L’analgésie postopératorie a été normalisée. On a comparé le délai d’installation et la durée du blocage sensitif et moteur, la durée de l’analgésie, le score de douleur postopératoire et les besoins analgésiques.
Réasultats: Chez les patients qui ont reçu de la clonidine, on a noté une perte sensitive de plus longue durée, de 489 min à 628 min avec une différence moyenne de 138 min (intervalle de confinance de 95%, de 90 à 187 min), un blocage moteur plus long de 552 min à 721 min avec une différence moyenne de 170 min (IC de 95%, de 117 à 222 min) et une meilleure analgésie de 587 min à 828 min avec une différence moyenne de 241 min (IC de 95%, de 188 à 294 min). Il n’y a pas eu de différence de délai d’installation. Aucun effet secondaire n’a été enregistré.
Conclusion: L’ajout de 150µg de clonidine à la ropivacaïne, pour un blocage du plexus brachial, prolonge le bloc moteur et sensitif et l’analgésie sans augmenter les effets secondaires.
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El Saied, A.H., Steyn, M.P. & Ansermino, J.M. Clonidine prolongs the effect of ropivacaine for axillary brachial plexus blockade. Can J Anesth 47, 962–967 (2000). https://doi.org/10.1007/BF03024866
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DOI: https://doi.org/10.1007/BF03024866