A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND, CONTROLLED CLINICAL STUDY OF ADJUVANT EFFECT OF FENTANYL (1 µg/kg) OR CLONIDINE (2µg / kg) TO ROPIVACAINE 0.2% 1ML/KG FOR CAUDAL ANALGESIA IN CHILDREN UNDERGOING LOWER ABDOMINAL SURGERIES

Abstract

prospective, randomized, double blind, controlled clinical study of adjuvant effect of fentanyl (1 μg/kg) or clonidine (2µg / kg) to ropivacaine 0.2% 1ml/kg for caudal analgesia in children undergoing lower abdominal surgeries".ABSTRACT: Ropivacaine having better safety profile and less motor blockade than bupivacaine is well suited for caudal analgesia. Since studies done regarding the effect of fentanyl and clonidine as adjuvants to ropivacaine for prolongation of caudal analgesia are scant and have shown conflicting results, the present study was conducted. METHODS: A total of 90 children aged between 3-6yrs belonging to ASA class I and II undergoing surgical procedures below the umbilicus were randomly allocated to one of two groups: Group R received ropivacaine 0.2%, 1 ml/kg with saline 0.02ml/kg and Group RF received ropivacaine 0.2%, 1 ml/kg with fentanyl 1 μg/kg (0.02ml/kg) and Group RC (clonidine) received 1ml/kg of 0.2% Ropivacaine plus clonidine 2µg / kg caudally after induction of general endotracheal anaesthesia. The pain score was evaluated using Hannallah pain scale, motor blockade using modified bromage scale and sedation assessed using 4 point sedation score at 30 minutes after extubation and at 1, 2, 4, 6, 12 and 24 h. The time to awakening, first analgesic requirement time, number of doses of rescue analgesic and side-effects in a 24 hours period were also recorded. The results were evaluated using SPSS 17 statistical method. RESULTS: There were no differences in demographic characteristics between the groups. However, mean duration of caudal analgesia was 659.5 minutes in group R, 784.5 minutes in group RF and 960.5 minutes in group RC which was statistically highly significant (P<0.01).The total dose of rescue analgesic in 24 hours was lower in groups RF and RC. Also the number of children receiving rescue analgesia at 12 hours was higher in placebo group than fentanyl group and clonidine group which was statistically highly significant (P<0.01). Increased incidence of urinary retention and pruritis was noted in group RF which was statistically not significant (P=0.366). CONCLUSION: Addition of inj. Fentanyl 1µg/kg or clonidine 2µg/kg to Ropivacaine 0.2% 1ml/kg prolongs the duration and improves the quality of analgesia post operatively when compared with Ropivacaine alone. However, clonidine is a better adjuvant to Ropivacaine 0.2% 1ml/kg for single shot caudal block in children undergoing infraumbilical surgeries due to more prolonged analgesia and lesser side effects.

A comparative study of caudal anesthesia with bupivacaine v/s bupivacaine with dexmedetomidine in lower abdominal surgeries in pediatric age group

“…Duration of analgesia was not significantly affected by any of the demographic variables (P > 0.05). Surgery type such as open appendectomy and orchidopexy + circumcision significantly affected the duration of analgesia (P = 0.041; P = 0.011 respectively) [19]. FLACC score during initial four hours and 12 th hours of post-surgery was significantly low in group BD (P < 0.05).…”