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Clonidine in pediatric caudal anesthesia
1Department of Anesthesiology and Intensive Care, Bicêtre Hospital, University of Paris-Sud, Le Kremlin-Bicêtre, France.
Insights
Adding clonidine to caudal bupivacaine significantly extends postoperative pain relief in children undergoing surgery. This study found clonidine enhanced analgesia duration and reduced pain scores compared to epinephrine or no additive.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Extradural clonidine is known to provide analgesia in adults.
- The efficacy of clonidine in pediatric pain management via caudal anesthesia requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of caudal clonidine in pediatric patients undergoing subumbilical surgery.
- To compare the duration and quality of postoperative analgesia with caudal bupivacaine alone, with added epinephrine, or with added clonidine.
Main Methods:
- A double-blind, randomized study involving 45 pediatric patients (1-7 years) undergoing subumbilical surgery.
- Patients received caudal anesthesia with bupivacaine, with either epinephrine (EG), clonidine (CG), or no additive (BG).
- Postoperative pain was assessed using the Broadman Objective Pain/Discomfort Scale (OPS) until the first analgesic administration.
Main Results:
- The clonidine group (CG) demonstrated a significantly longer duration of analgesia (987 min) compared to the epinephrine (EG, 377 min) and control (BG, 460 min) groups (P < 0.01).
- Maximal OPS scores were lower in the CG (2.3) versus EG (3.4) and BG (3.4) (P < 0.05).
- Fewer patients in the CG required postoperative analgesia (n=7) compared to EG (n=1) and BG (n=2) (P < 0.05).
Conclusions:
- The addition of 1 microgram/kg of clonidine to caudal bupivacaine significantly increases the duration of postoperative analgesia in pediatric patients.
- Caudal clonidine is an effective adjuvant for enhancing pain management in children undergoing subumbilical surgery without adverse respiratory or hemodynamic effects.
Abstract:
Extradural clonidine produces analgesia in adults. To assess its efficacy in children, we randomized 45 pediatric patients aged 1-7 yr presenting for a subumbilical surgery into three groups of 15 each. After halothane and N2O/O2 induction, and with a double-blind protocol, caudal anesthesia was performed with 1 mL/kg of 0.25% bupivacaine. Epinephrine 1/200,000 was added in one group (EG), 1 microgram/kg of clonidine in another group (CG), and no additional medication in the last group (BG). Postoperative analgesia was evaluated using the Broadman "objective pain/discomfort scale" (OPS) at 1-h intervals until the first analgesic administration. There were no differences among the groups in age, weight, duration of surgery, baseline systolic arterial pressure, and heart rate. The mean (+/- SD) duration of analgesia was longer in the CG (987 +/- 573 min) than in the EG (377 +/- 341 min) and BG (460 +/- 439 min); P < 0.01. The maximal OPS scores were lower in the CG than in the EG and BG (2.3 +/- 1.6 vs 3.4 +/- 1.4 and 3.4 +/- 1.8, respectively; P < 0.05). More patients in the CG (n = 7) than in the EG (n = 1) and BG (n = 2) required no postoperative analgesia; P < 0.05. No differences were found among the groups for the minimal respiratory rate and minimal Spo2 values in the postoperative phase, and there were no differences among the groups for heart rate and systolic arterial pressure during the 3 h after caudal anesthesia. We conclude that the duration of postoperative analgesia with caudal bupivacaine was significantly increased by the addition of 1 microgram/kg of clonidine.