牙科麻醉中可乐定对利多卡因局麻的影响
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Effect of clonidine on the efficacy of lignocaine local anesthesia in dentistry: A systematic review and meta-analysis of randomized, controlled trials
背景与目的
局麻中利多卡因可以混合肾上腺素，肾上腺素可被可乐定所替代，此种替代在各种随机对照试验中进行了试验。因此，当前此系统评价的目的是收集利多卡因加可乐定行牙科麻醉的证据。
方 法
搜寻了电子数据库进行适当的研究。创建新的数据提取形式，使用RevMan 5.3软件中的非Cochrane模式分析提取数据。使用森林图，I2统计量（其中> 50％被认为具有中度至重度差异性）和χ2检验来评估研究之间的差异。中等差异性使用随机效应模型。最后回顾包括了五项研究。
结 果
发现可乐定在主观测量时明显缩短了局部麻醉的起效时间，客观上没有观察到显着性差异。在持续时间和术后镇痛方面没有观察到明显差异。术后观察到在使用可乐定时血流动力学参数稳定。
结 论
有肾上腺素使用禁忌症的情况下，如心脏异常，高血压和糖尿病，可乐定可替代肾上腺素。
原始文献摘要
Gowri Sivaramakrishnan，Kannan Sridharan. Effect of clonidine on the efficacy of lignocaine local anesthesia in dentistry: A systematic review and meta-analysis of randomized, controlled trials.[J] Oral and Maxillofacial Surgery,2017,2(6), DOI: 10.1111/jicd.12296
Abstract
Alternatives to adrenaline with lignocaine local anesthesia, such as clonidine, have
been trialed in various randomized, controlled trials. Therefore, the aim of the present
systematic review was to compile the available evidence on using clonidine with lignocaine for dental anesthesia. Electronic databases were searched for eligible studies. A data-extraction form was created, extracted data were analyzed using non-Cochrane
mode in RevMan 5.3 software. Heterogeneity between the studies were assessed using the forest plot, I2 statistics (where >50% was considered to have moderate-tosevere heterogeneity), and χ2-test. Random-effects models were used because of moderate heterogeneity. Five studies were included for the final review. While clonidine was found to significantly shorten the onset of local anesthesia when measured subjectively, no significant difference was observed objectively. No significant difference was observed in the duration and postoperative analgesia. Stable hemodynamic parameters within the safe range were observed postoperatively when clonidine was used. Clonidine could be considered as an alternative to adrenaline in cases of contraindications to adrenaline, such as like cardiac abnormalities, hypertension, and diabetes.
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