Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade

Joshi, Wanda; Connelly, Neil Roy; Freeman, Katharine; Reuben, Scott S.

doi:10.1111/j.1460-9592.2004.01229.x

Cited by 36 publications

(34 citation statements)

References 14 publications

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“…This result is not consistent with the results of the studies that used clonidine (2 µg/kg) with a low concentration (0.125%) of bupivacaine (1 mL/kg), in which analgesic efficacy was not significantly improved. [22][23][24] The authors of those studies speculated that clonidine 2 µg/kg may not be effective with a lowconcentration of bupivacaine, although the exact mechanism is unclear. However, DEX is a more selective α2-adrenoceptor agonist and is eight times potent than clonidine.…”

Section: Discussionmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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When local anesthetics are used, the administration of dexmedetomidine (DEX) can prolong analgesic duration. However, the effect of caudal DEX on high volume/low concentration (HVLC) local anesthetics has not been studied. We investigated the analgesic effect of DEX added to a HVLC of ropivacaine for caudal block in children. Eighty children (the American Society of Anesthesiologists (ASA) status I; age, 1-6 years) undergoing ambulatory orchiopexy were enrolled in the study. Children were randomly assigned to undergo a caudal block with 1.5 mL/kg of 0.15% ropivacaine and either 1 µg/kg of DEX (DEX group, n 40) or the same amount of saline (Control group, n 40) under general anesthesia. The results showed that the time to first analgesic request was significantly longer in the DEX group than in the control group. The sevoflurane requirement for anesthesia and frequency of emergence agitation (EA) were also significantly lower in the DEX group. There was no difference in adverse events between the two groups. In conclusion, a dose of 1 µg/ kg of caudal DEX prolonged the first analgesic request time, although the immediate postoperative pain scores were comparable in both groups. Furthermore, caudal DEX significantly reduced the sevoflurane requirement and the frequency of EA.Key words dexmedetomidine; caudal block; child; orchiopexy Caudal block is common method for postoperative analgesia in children undergoing infra-umbilical surgery. One major limitation of caudal block is a relatively short analgesic duration owing to the single-injection. Thus, adjuvants such as ketamine, clonidine, or opioids are frequently added to the local anesthetics in order to improve analgesic efficacy and duration.1,2) The effectiveness of local anesthetics using in caudal block is dependent upon the dose, volume, and concentration of the local anesthetic solution, but high-concentration local anesthetics can increase the incidence of motor weakness, delayed micturition, or urinary retention. In children undergoing ambulatory surgery, such adverse effects can prolong the discharge time and may result in inadvertent admission. Recently, high-volume/low-concentration (HVLC) regimens for caudal blocks in children (1.5 mL/kg of 0.1-0.2% local anesthetics) have gained popularity following a report by Silvani et al. that demonstrated that a HVLC regimen provides a longer analgesic duration with less adverse effects than conventional dose/concentration. [3][4][5][6][7][8] However, the analgesic duration is still limited in caudal block with single-injection.Dexmedetomidine (DEX) is a highly selective α 2 adrenoceptor agonist with an α2/α1 selectivity ratio of 1600 : 1, and is eight times more potent than clonidine. 9) DEX is successfully used as an adjuvant in caudal blocks for children in order to reduce pain without inducing any significant respiratory and hemodynamic effects. Several studies have reported that in children, caudal DEX (1-2 µg/kg) with 0.25% bupivacaine (1 mL/kg) prolongs postoperative analgesic duration by 2.5-3 fold comp...

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Section: Discussionmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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“…Eisenach et al 16 suggested that the risk of hypotension and bradycardia is an expected side effect of extradural Clonidine in adults but it is less pronounced in children. Wanda Joshi et al 17 (2004) did not recommend adding Clonidine to Bupivacaine caudal block in children undergoing surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of Caudal Fentanyl and Clonidine as Adjuvant to Bupivacaine for Post- Operative Analgesia in Pediatric Genitourinary and Inguinal Surgeries

Gupta¹,

Vatsalya²,

Mehrotra³

2014

jemds

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Post-operative analgesia in children is a challenging task before the anesthesiologist. Caudal analgesia is an accepted and popular method of providing intraoperative and postoperative analgesia for genitourinary and inguinal surgeries in children. Because of short duration of action of Bupivacaine, various adjuncts have been tried by many anesthesiologists. Fentanyl and Clonidine are used along with local anesthetics to prolong duration of analgesia. Hence we are comparing 1 mcg/kg of Fentanyl and 1 mcg/kg of Clonidine as adjuvants to 0.25% bupivacaine at a volume of 0.75 ml/kg in children undergoing genitourinary and inguinal surgeries. AIMS AND OBJECTIVES: To compare the efficacy of Fentanyl and Clonidine as adjuncts to Bupivacaine for postoperative analgesia in pediatric patients and to evaluate the sequel and side effects of both. MATERIALS AND METHODS: Study design -Comparative randomized controlled study. Sample size: 120 children aged between 2-7 years posted for genitourinary and inguinal surgeries. Group I (B) received 0.75 ml/kg of 0.25% Bupivacaine alone caudally. Group II (BF) received 0.75 ml/kg of 0.25% Bupivacaine and 1 µg/kg Fentanyl caudally. Group III (BC) received 0.75 ml/kg of 0.25% Bupivacaine and 1 µg/kg Clonidine caudally. Postoperatively the duration of analgesia, motor blockade and sedation was assessed by Modified Objective Pain Scale, Ramsay Sedation Score and modified Bromage scale respectively. Side effects and complications, if present were recorded. Tests used for statistical analysis were Fishers exact test and student t test. RESULTS: The mean duration of analgesia in group BC (601.5 + 60.17 minutes) was much higher than group BF and B but with side effect of sedation. We observed that there was a statistically increased duration of analgesia in Clonidine group as compared to Fentanyl and plain Bupivacaine group with no difference in duration of motor blockade. There was increased sedation in group BC. Group BF had nausea and vomiting, shivering and pruritus as side effects. Hence we conclude that Clonidine is a better adjunct than Fentanyl in prolonging duration of analgesia of Bupivacaine in pediatric caudal block.

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“…Incidence of bradycardia was higher in group C compared to group B. 10 It was treated with injection atropine 0.01 mg/kg I.V. Mean time of first micturation was comparable in both the groups and there was no significant difference in both the groups (p <0.05).…”

mentioning

confidence: 87%

A comparative study to compare the efficacy of hyperbaric bupivacaine alone and hyperbaric bupivacaine with clonidine in caudal block in paediatric lower abdominal surgeries

2017

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Background: The aim was to compare the efficacy of addition of clonidine to hyperbaric bupivacaine and to compare it with plain hyperbaric bupivacaine for caudal analgesia in children aged 3 months to 3 years in term of analgesic duration, hemodynamic change and degree of sedation.Methods: Sixty ASA I and II children undergoing lower abdominal surgeries were divided into two groups of 30 each, plain hyperbaric bupivacaine group (Group B) and hyperbaric bupivacaine with clonidine group (Group C). Group B received only bupivacaine and Group C received bupivacaine with clonidine in caudal block.Results: Hemodynamic and demographic profiles were comparable between both the groups. Addition of clonidine significantly prolonged duration of caudal analgesia and significantly reduce the FLACC scores in group C as compared to group B. Mean sedation score immediately after postoperative period was higher in group C but after 4 hours of awakening, there was gradual fall in mean sedation score in both groups.Conclusions: Addition of clonidine to bupivacaine in caudal analgesia significantly increases the duration of post-operative analgesia.

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Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade

Abstract: We do not recommend adding clonidine (2 microg.kg(-1)) to a bupivacaine (0.125%) caudal block in children undergoing surgery.

Cited by 36 publications

References 14 publications

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Comparative Evaluation of Caudal Fentanyl and Clonidine as Adjuvant to Bupivacaine for Post- Operative Analgesia in Pediatric Genitourinary and Inguinal Surgeries

A comparative study to compare the efficacy of hyperbaric bupivacaine alone and hyperbaric bupivacaine with clonidine in caudal block in paediatric lower abdominal surgeries

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