Zusammenfassung:
In einer randomisierten Doppelblindstudie wurde bei 60 Patienten mit axillärer Plexus brachialis-Blockade der Einfluss von Clonidin oder Tramadol als Zusatz zum Lokalanästhetikum Prilocain untersucht. Die Patienten wurden in drei Gruppen eingeteilt. Gruppe A erhielt 40 ml Prilocain 1,5 % plus Tramadol 1,5 mg/kg KG, Gruppe B 40 ml Prilocain 1,5 % plus Clonidin 1,5 μg/kg KG und Gruppe C 40 ml Prilocain 1,5 % ohne weitere Zusatzmedikation. Neben Herzfrequenz, Blutdruck, Sauerstoffsättigung und Grad der Sedierung wurde in den ersten 30 Minuten nach Anlage der axillären Plexusblockade die Entwicklung der sensorischen und motorischen Blockade in regelmäßigen Abständen erfasst. Die Gesamtdauer der Schmerzfreiheit, der motorischen und sensorischen Blockade wurde dokumentiert und statistisch ausgewertet. Hinsichtlich Anschlagszeit und Analgesiedauer wiesen die drei Gruppen keinen signifikanten Unterschied auf. Der Clonidinzusatz zeigte eine signifikante Verlängerung der sensorischen und motorischen Blockade. Die Vitalparameter waren in allen drei Gruppen stabil, übermäßige Sedierung oder Blutdruckabfälle wurden nicht beobachtet. Clonidin und Tramadol als Zusatz zur axillären Plexusblockade konnten in unserer Untersuchung keinen therapeutischen Vorteil erzielen.
Abstract
In a randomized, double-blind study we investigated the effect of clonidine and tramadol added to prilocaine on duration of analgesia, sensory and motor brachial plexus block. 60 patients were randomized in three groups. Group A received 40 ml prilocaine 1,5 % with tramadol 1,5 mg/kg KG, group B 40 ml prilocaine 1,5 % plus clonidine 1,5 μg/kg KG and group C 40 ml prilocaine 1,5 % without any additional medication. We recorded heart rate, blood pressure, oxygen saturation and sedation score at regular intervals. The onset of sensory and motor block was tested every five minutes for thirty minutes. The duration of analgesia, sensory and motor block were evaluated by using a questionnaire. There was no difference between the three groups concerning onset of brachial plexus block and duration of analgesia. But there was a significant prolongation of the duration of sensory and motor block in group B. Haemodynamic parameters remained stable in all patients, there were no significant changes in blood pressure and sedation.
Schlüsselwörter
Plexus brachialis-Blockade - Adjuvanzien - Clonidin - Tramadol - Lokalanästhesie
Key words
Brachial plexus block - clonidine - tramadol - adjunct - local anaesthetic solution
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Dr. med. Ole Broch, D.E.A.A.
Klinik für Anästhesiologie und Operative Intensivmedizin
Universitätsklinikum Schleswig-Holstein, Campus Kiel · Schwanenweg 21 · 24105 Kiel
eMail: broch@anaesthesie.uni-kiel.de
