A STUDY ON EVALUATION OF SAFETY AND EFFICACY OF CLONIDINE AS AN ADJUNCT TO BUPIVACAINE IN CAUDAL BLOCK IN PAEDIATRIC PATIENTS (original) (raw)
Related papers
Journal of Evolution of medical and Dental Sciences, 2015
Caudal epidural analgesia with bupivacaine is common in paediatric anaesthesia for providing intra and postoperative analgesia. But duration of analgesia even with bupivacaine; long acting anaesthetic is short only 4-6hrs. Hence, several adjuvants have been tried to prolong the duration of action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesic effect provided by caudal bupivacaine in children undergoing infraumbilical surgery. Forty children, aged one to seven years, American Society of Anaesthesiologists (ASA) Grade I/II, undergoing infra-umbilical surgery, were included in prospective randomized double blind study to one of two groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group A) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with 1 µg/kg of clonidine in normal saline (Group B). Post-operative pain was assessed for 24 hours using the Objective Pain Scale (OPS). The mean duration of analgesia was significantly longer in Group B (10.2 Hrs.) than in Group A (4.2 1Hrs); P<0.05, which was statistically significant. In both the groups, there were no significant changes in the heart rate and mean arterial pressure from the baseline value, in the intraoperative as well as postoperative period (p>0.05). The requirement of rescue medicine was lesser in Group B. Clonidine as an adjunct to bupivacaine prolongs the post-operative pain relief in children and is safe compared to bupivacaine alone in paediatric infra umbilical surgeries.
Caudal analgesia is an accepted and popular method of providing intra and postoperative analgesia for abdominal, perineal and lower limb surgeries in children. Caudal epidural block with bupivacaine is one of the most common regional anesthetic technique used in children. Several adjuncts such as opioids, ketamine, midazolam and neostigmine have been used with bupivacaine to prolong its action and thus extend the duration of postoperative analgesia provided by 'single shot' caudal technique. Clonidine, an α2 agonist has extensively been used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine without significant respiratory depression after systemic, epidural and spinal administration. Hence, this study was conducted to know the efficacy and safety of clonidine as an adjuvant to bupivacaine in single shot caudal block in children.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Children are not as expressive as adults, but they do feels pain equally. In the perioperative period, pain is the most alarming, upsetting and disturbing symptom for a patient. In pediatric populace, amongst the regional blocks, caudal epidurals with local anesthetics are preferred and universally practiced by anesthesiologists, but comparatively shorter period of analgesia is its major limitation. So, to improve the effectiveness of caudal epidurals, a variety of additives are used besides local anesthetics. Materials and Method: A double-blind, prospective and randomised study was carried on 60 children falling in the age group of 1-6 years belonging to ASA I or II, posted to undergo surgery infraumblically, were allocated randomly to one of two groups of 30 each who then received injection of 0.25% bupivacaine-clonidine(2ug/kg) or 0.25% ropivacaine-clonidine (2μg/kg) @ 1ml/kg caudally. Haemodynamic variables were documented peri-operatively. Pain was assessed using the Modified Hanallah pain score for 24 hours and complications were observed in the postoperative period. Results: No statistically significant difference was observed when 2ug/kg of clonidine added to 0.25% bupivacaine or 0.25% ropivacaine caudally in pediatric patients, in procedures below the umbilicus with mean duration of analgesia with group BC and RC were mins respectively. Also no significant undesirable side effects like bradycardia, hypotension, urinary incontinence, nausea and vomiting were observed in either of these groups. Conclusion: The mean extent of analgesia was equally prolonged in both the groups postoperatively. So, clonidine in a dose of 2ug/kg added to 0.25% bupivacaine or 0.25% ropivacaine for caudal analgesia, proves safe and effective method in prolonging the duration of analgesia without producing any significant side effects.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Caudal epidural block is a highly popular method of administering analgesia to children undergoing infraumbilical surgeries. Addition of clonidine, a centrally acting alpha 2 agonist as an adjuvant to caudal bupivacaine has added advantages of providing prolonged post-operative analgesia and also, thus reducing the number of doses of post-operative rescue analgesics. In this study, we wanted to compare the efficacy and safety of caudally administered clonidine as an adjuvant to bupivacaine. METHODS This was a prospective, comparative interventional study and was conducted in the Department of Anaesthesia at JNMC, Sawangi (Meghe) Wardha in accordance with the guidelines and permission of the institutional ethical review board. The study was carried out with 40 patients in each group randomly allocated using computer generated software, posted for infraumbilical surgeries between the age group 2 years to 7 years, American Society of Anaesthesiologists (ASA) grade I and II. ...
Effects of Adding Clonidine to Bupivacaine for Caudal Analgesia in children
Journal of Medical Science And clinical Research, 2017
Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra and postoperative analgesia. Several adjuvants have been used to prolong the action of caudal bupivacaine. We evaluated the effect of clonidine added to caudal bupivacaine in prolonging the analgesia in children undergoing sub-umbilical surgery. 80 children in the age group two to eight belonging to American Society of Anaesthesiologists Physical Status I & II undergoing lower abdominal surgeries were prospectively randomized to one of two groups of 40: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 1 ml/kg of 0.25% bupivacainewith1 µg/kg of clonidine in normal saline (Group BC).Post-operative pain was assessed for 24 hours using the Observational Pain/Discomfort Scale (OPS). The mean duration of analgesia was significantly longer in Group BC(12.18 hour) than in Group B (4.85 hour); P < 0.05. The pain score assessed using OPS scale was compared between the two groups and children in Group BC had lower pain scores, which was found to be statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 µg/kg added to 0.25% bupivacaine for caudal analgesia during sub-umbilical surgeries significantly prolongs the duration of analgesia of bupivacaine without any major side effects.
Ain-Shams Journal of Anesthesiology, 2022
Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant. Methods and Objective of study: This is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3-13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/ kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 μg/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia. Results: The mean onset of sensory block was 3.04 ± 1.5 min in group BC vs. 5.01 ± 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 ± 0.38 min vs. 6.47 ± 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 ± 33 min in group BC vs. 194.5 ± 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T 5. Conclusions: We infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T 8 dermatome.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. METHODS The children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. RESULTS Group B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. CONCLUSIONS Addition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.
British Jrnl Anaesthesia, 2011
† The use of clonidine or morphine to prolong analgesia provided by caudal bupivacaine was compared in children undergoing upper abdominal surgery. † Clonidine increased the duration of analgesia and sedation with fewer side-effects compared with morphine. † Clonidine was a safe and effective supplement to caudal bupivacaine analgesia for upper abdominal surgery. Background. Various additives have been used to increase the duration of analgesia provided by bupivacaine administered by single-shot caudal injection in children. Methods. A prospective, randomized, double-blind controlled study in 50 ASA I-II children (34 boys and 16 girls) aged 1-6 yr undergoing upper abdominal surgery was conducted. Patients were divided into two groups to receive either morphine 30 mg kg 21 (MB) or clonidine 2 mg kg 21 (CB) in bupivacaine 0.2% (1.25 ml kg 21) for caudal analgesia. The duration of analgesia (FLACC scale) and sedation and side-effects such as vomiting, itching, respiratory depression, hypotension, and bradycardia were observed. Results. The mean duration of analgesia was 16.5 (3.6) h in the CB group compared with 10.2 (2.3) h (P,0.01) in the MB group. Subjects who received clonidine (CB) were sedated for longer [7.1 (0.8) h] compared with the MB group [3.8 (0.7) h; P,0.01]. Vomiting was observed in 4% and 12% of subjects in the CB and MB groups, respectively. Sixteen per cent of subjects reported itching in the MB group (P¼0.03), and none in the CB group. No hypotension, bradycardia, or respiratory depression was observed in any subjects. Conclusions. Caudal clonidine 2 mg kg 21 in bupivacaine 0.2% provides a longer duration of analgesia and sedation compared with caudal morphine 30 mg kg 21 in bupivacaine 0.2% without significant side-effects in children undergoing upper abdominal surgery.
British Journal of Anaesthesia, 2011
† The use of clonidine or morphine to prolong analgesia provided by caudal bupivacaine was compared in children undergoing upper abdominal surgery. † Clonidine increased the duration of analgesia and sedation with fewer side-effects compared with morphine. † Clonidine was a safe and effective supplement to caudal bupivacaine analgesia for upper abdominal surgery. Background. Various additives have been used to increase the duration of analgesia provided by bupivacaine administered by single-shot caudal injection in children. Methods. A prospective, randomized, double-blind controlled study in 50 ASA I-II children (34 boys and 16 girls) aged 1-6 yr undergoing upper abdominal surgery was conducted. Patients were divided into two groups to receive either morphine 30 mg kg 21 (MB) or clonidine 2 mg kg 21 (CB) in bupivacaine 0.2% (1.25 ml kg 21) for caudal analgesia. The duration of analgesia (FLACC scale) and sedation and side-effects such as vomiting, itching, respiratory depression, hypotension, and bradycardia were observed. Results. The mean duration of analgesia was 16.5 (3.6) h in the CB group compared with 10.2 (2.3) h (P,0.01) in the MB group. Subjects who received clonidine (CB) were sedated for longer [7.1 (0.8) h] compared with the MB group [3.8 (0.7) h; P,0.01]. Vomiting was observed in 4% and 12% of subjects in the CB and MB groups, respectively. Sixteen per cent of subjects reported itching in the MB group (P¼0.03), and none in the CB group. No hypotension, bradycardia, or respiratory depression was observed in any subjects. Conclusions. Caudal clonidine 2 mg kg 21 in bupivacaine 0.2% provides a longer duration of analgesia and sedation compared with caudal morphine 30 mg kg 21 in bupivacaine 0.2% without significant side-effects in children undergoing upper abdominal surgery.
National Journal of Medical Research, 2017
Introduction: Clonidine, an a2 adrenergic agonist, prolongs analgesia without significant respiratory depression. The analgesic action of epidurally-administered clonidine is due to stimulation of descending noradrenergic medullospinal pathways inhibiting the release of nociceptive neurotransmitters in the dorsal horn of spinal cord. The present study was done with the objective of assessing advantages of use of clonidine with Ropivacaine for caudal analgesia in paediatric age group among lower abdominal and lower limb surgery. Methodology: A randomized controlled study consisted in two groups of thirty paediatric patients (1-10 years) each with lower abdominal and lower limb surgery was carried out at Department of Anaesthesia, SMIMER Hospital, Surat during Jan to Dec 2012.Total 60 patients were randomly allocated in two groups by chit method. In Group R patients Inj.Ropivacaine0.25% (0.5 ml/kg) was given and in Group RC patients Inj. Ropivacaine 0.25%(0.5 ml/kg)+ Inj. Clonidine 2mg/kg was given. Patients were assessed for pain Modified objective pain score and sedation assessed with Four Point sedation score. Results: Mean age of patient was 4.77 ± 2.487 years in Group R and 5.37 ± 2.723 yrs in Group RC. Total Male:Female ratio was 9:1. Majority of patients were operated for congenital herniotomy (68.3%) followed by Hypospadiasis repair (16.6%).Mean modified pain score was measured at each hour postoperatively. It was higher at each level in Group R and this difference was statistically significant. The mean duration of analgesia was 7.17 hrs in Group R and 12.93 hrs in Group RC. This difference was also statistically significant (p-Value < 0.001). Conclusion: From the study, it was concluded that the addition of clonidine 2µg/kg to single shot caudal block with Ropivacaine 0.25% prolongs the duration of postopertive analgesia while maintaining hemodynamic stability. Clonidine 2µg/kg is safe & effective adjuvant in caudal block for paediatric lower abdominal and lower limb surgery.