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Caudal clonidine prolongs analgesia from caudal S(+)-ketamine in children
Helmut Hager1, Peter Marhofer, Christian Sitzwohl
1Department of Anesthesia and Intensive Care Medicine, University of Vienna, Austria.
Insights
Adding clonidine to caudal S(+)-ketamine significantly extends postoperative analgesia in pediatric surgery. This combination provides excellent pain relief for up to 24 hours with minimal side effects.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Caudal blockade is a common technique for pediatric surgical pain management.
- Optimizing the duration and efficacy of caudal analgesia is crucial for patient recovery.
Purpose of the Study:
- To evaluate the efficacy and safety of preservative-free S(+)-ketamine alone versus in combination with clonidine for caudal blockade in pediatric surgery.
- To determine the optimal dosage of clonidine for enhanced postoperative analgesia.
Main Methods:
- Prospective, randomized, double-blinded study involving 53 children (1-72 months) undergoing inguinal hernia repair.
- Caudal injection of S(+)-ketamine (1 mg/kg) alone or with clonidine (1 or 2 microg/kg) under sevoflurane anesthesia.
- Monitoring of intraoperative vitals and postoperative pain and sedation scores.
Main Results:
- The combination of S(+)-ketamine with clonidine significantly prolonged postoperative analgesia (21.8-22.7 hours) compared to S(+)-ketamine alone (13.3 hours) (P < 0.0001).
- Groups receiving clonidine required significantly fewer postoperative analgesics (15-18%) versus the S(+)-ketamine only group (63%) (P < 0.01).
- All groups exhibited similar, favorable postoperative sedation scores.
Conclusions:
- Caudally administered preservative-free S(+)-ketamine combined with 1 or 2 microg/kg clonidine provides excellent perioperative analgesia in children.
- This combination offers prolonged pain relief for up to 24 hours with minimal adverse effects, enhancing recovery after pediatric surgery.
Unlabelled:
We performed a prospective randomized double-blinded study to test preservative-free S(+)-ketamine alone or in combination with clonidine for intra- and postoperative caudal blockade in pediatric surgery over a 24-h period. Fifty-three children (1-72 mo) scheduled for inguinal hernia repair were caudally injected with either S(+)-ketamine 1 mg/kg alone (Group K) or with additional clonidine (Group C1 = 1 microg/kg; Group C2 = 2 microg/kg) during sevoflurane anesthesia via a laryngeal mask. Intraoperative monitoring included heart rate, blood pressure, and pulse oximetry; postoperative monitoring included a pain discomfort scale and a sedation score. No additional analgesic drugs were required during surgery. The mean duration of postoperative analgesia was 13.3 +/- 9.2 h in Group K, 22.7 +/- 3.5 h in Group C1, and 21.8 +/- 5.2 h in Group C2 (P < 0.0001, Group K versus other groups). Groups C1 and C2 received significantly fewer analgesics in the postoperative period than Group K (15% and 18% vs 63%; P < 0.01). The three groups had similar postoperative sedation scores. We conclude that the combination of S(+)-ketamine 1 mg/kg with clonidine 1 or 2 microg/kg for caudal blockade in children provides excellent analgesia without side effects over a 24-h period.
Implications:
Caudally administered preservative-free S(+)-ketamine combined with 1 or 2 microg/kg clonidine provides excellent perioperative analgesia in children and has minimal side effects.