Title UČINAK LOKALNOG ANESTETIKA I
KLONIDINA NA TIHI KOŽNI PERIOD
TIJEKOM I NAKON SPINALNE
ANESTEZIJE Title (english) THE EFFECT OF LOCAL ANESTHETIC
AND CLONIDINE ON THE CUTANEOUS
SILENT PERIOD DURING AND AFTER
SPINAL ANESTHESIA Author Sandra Graf Župčić Mentor Silvio Bašić (mentor)Mentor Željko Župančić (komentor)Committee member Jasenka Mršić-Pelčić (predsjednik povjerenstva)Committee member Mario Habek (član povjerenstva)Committee member Alan Šustić (član povjerenstva)Committee member Silvio Bašić (član povjerenstva)Committee member Željko Župan (član povjerenstva)Granter University of Rijeka Defense date and country 2019-06-28, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 61 - Medical sciences ThesaurusMESH - Medical Subject Headings )
Clonidine
Anesthesia, Local
Anesthesia, Spinal
Reflex
Abstract Cilj istraživanja: Dosadašnja istraživanja pokazala su korelaciju između oštećenja A delta
(Aδ) vlakana i spinotalamičkog puta s jedne strane te trajanja tihog kožnog perioda (TKP) i
njegove latencije s druge strane. Klonidin dodan intratekalno levobupivakainu, produžuje
osjetni, motorički blok i trajanje analgezije. Navedeni učinak ostvaruje putem A delta (Aδ), C
vlakana i gelatinozne tvari u kralježničnoj moždini. S obzirom da klonidin najjači analgetski
učinak ostvaruje kod intratekalne primjene, smatra se da je primarno mjesto djelovanja
klonidina kralježnična moždina. Cilj ovog istraživanja bio je utvrditi postoji li utjecaj
intratekalno dodanog klonidina levobupivakainu kod subarahnoidalnnog bloka (SAB) na
trajanje TKP-a i latencije u odnosu na intratekalnu primjenu otopine samog levobupivakaina.
Specifični ciljevi ovog istraživanja bili su pokazati postoji li utjecaj intratekalno dodanog
klonidina levobupivakainu kod SAB-a na trajanje motoričkog i osjetnog bloka te na trajanje
perioperacijske analgezije.
Ispitanici i metode: Randomizirana prospektivna monocentrična, dvostruko slijepa studija
provodila se od svibnja 2017. do listopada 2017. u Kliničkoj bolnici Dubrava, Zagreb,
Hrvatska. U studiju je bilo uključeno 67 bolesnika oba spola, 18-60 godina bez simptoma i
znakova poremećaja perifernog i centralnog živčanog sustava, a koji su bili predviđeni za
operaciju ingvinalne kile. Bolesnici su randomizirani u dvije skupine s obzirom na primjenu
otopine lokalnog anestetika levobupivakaina s dodatkom klonidina nasuprot primjeni otopine
levobupivakaina bez klonidina [34 bolesnika u levobupivakain-klonidin skupini (LKS) i 33
bolesnika u levobupivakain skupini (LS)]. TKP i njegova latencija mjereni su četiri puta: prije
primjene SAB-a, nakon regresije motoričkog bloka u Bromage 0 za vrijeme još prisutne
osjetne blokade, šesti i 24. sat od primjene SAB-a.
Rezultati: TKP je bio statistički značajno kraći u LKS nego u LS skupini tijekom 24 sata
(P=0.004), a latencija je bila statistički značajno duža u LKS skupini nego u LS skupini
tijekom 24 sata (P=0.001). LKS skupina u odnosu na LS skupinu imala je statistički značajno
duže trajanje regresije motoričkog bloka (P<0.001), statistički značajno duže trajanje osjetnog
bloka na operiranoj strani (P<0.001) te statistički značajno duže trajanje analgezije
(P<0.001). U LKS skupini u odnosu na LS skupinu vrijeme primjene prve, odnosno druge
analgetske terapije bilo je statistički značano duže (P<0.001). Nije postojala statistički
značajna razlika u učestalosti hipotenzije i bradikardije niti je postojala statistički značajna
razlika u učestalosti primjene efedrina i atropina između ispitivanih skupina.
Zaključak: Intratekalna primijena klonidina kao dodatak levobupivakainu kod SAB-a
rezultira značajno kraćim trajanjem TKP-a i značajno dužim trajanjem njegove latencije.
Sukladno tome može se zaključiti da tijekom regresije SAB-a, male doze intratekalno
primjenjenog klonidina, smanjuju inhibitorni tonus i ubrzavaju provođenje u
oligosinaptičkom spinalnom krugu.
Abstract (english) Objective: Research to date, has revealed a correlation between damage to the A delta (Aδ),
fibers, spinothalamic dysfunction and duration of the cutaneous silent period (CSP) and its
latency. Clonidine added to levobupivacaine and administered intrathecally prolongs
analgesia. It is considered that this effect is mediated via the Aδ, C-fibres and substantia
gelatinosa in the spinal medulla. Considering that its analgesic effect is the strongest after
intrathecal administration, it is deemed that the primary effect site of the action of clonidine
is the spinal medulla. I aimed to establish whether the addition of clonidine to
levobupivacaine for subarachnoid block (SAB), would influence the duration and latency of
the CSP in comparison to levobupivacaine alone. A specific aims were to determine whether
there were differences in duration of the motor, sensory block and duration of analgesia
between the two studied groups.
Patients and methods: This was a randomized, prospective, single-centre, double blind trial
conducted from May 2017 to October 2017 in Clinical Hospital Dubrava, Zagreb, Croatia. A
total of 67 male and female patients were included in this trial. They were 18-60 years of age,
without neurological disorders and were scheduled for inguinal hernia repair surgery. The
patients were randomized into two groups with regard to the intrathecally administered
solution, either levobupivacaine with clonidine or levobupivacaine alone [34 patients in the
levobupivacaine-clonidine (LC) group and 33 patients in the levobupivacaine (L) group]. CSP
and its latency were measured four times: prior to the SAB, after motor block regression to
Bromage 0 level of the Bromage scale with sensory blockade still present and 6 and 24 hours
after SAB.
Results: The CSP was statistically significantly shorter in the LC group during the 24-hour
period (P=0.004), while the latency was statistically significantly longer in the LC group
during the 24-hour period (P=0.001). The LC group had a significantly longer regression time
of the motor block on the operated side, a longer time of sensory regression on the operated
side, a longer duration of anagesia after SAB application and longer times of first and second
use of nonstereoidal anti-inflammatory drugs (P<0.001). Between groups, there was no
statistically significant difference in the incidence of hypotension and bradycardia nor in the
administration of ephedrine and atropine.
Conclusion: Intrathecal administration of clonidine to levobupivacaine for SAB results in a
statistically shorter duration of CSP and a significant prolongation of its latency. Accordingly,
I can conclude that during SAB regression, a small dose of intrathecally administered
clonidine ameliorates the inhibitory tonus and accelerates the conduction in the oligosynaptic
spinal circuit.
Keywords
Klonidin
Lokalni anestetici
Živčana vlakna
Spinalna anestezija
Refleks
Keywords (english)
Clonidine
Local anesthetics
Nerve fibers
Spinal anesthesia
Reflex
Language croatian URN:NBN urn:nbn:hr:184:740528 Study programme Title: Biomedicine Postgraduate (doctoral) study programme Type of resource Text File origin Born digital Access conditions Access restricted to students and staff of home institution Terms of use Created on 2020-01-24 13:39:38
