Clonidine in Pediatric Caudal Anesthesia

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.

Epidural and subarachnoid blockade in children

“…The addition of clonidine 2 mg.kg À1 to mepivacaine 7 mg.kg À1 for caudal epidural use in children aged 1-10 years undergoing subumbilical surgery increased the duration of effective analgesia (as assessed by an objective pain score of 6) from 143 min to 218 min [44]. Paediatric studies have found no differences between groups receiving caudal clonidine and control groups in the occurrence of significant haemodynamic or respiratory changes [41,42]. Mild postoperative sedation lasted longer following caudal bupivacaine 1 ml.kg À1 with clonidine 2 mg.kg À1 (mean 9.1 h) than plain bupivacaine (mean 5.8 h) [42].…”

Caudal Ropivacaine with Clonidine as Adjuvant In InfraUmbilical Pediatric Surgeries for Intra-Operative And PostOperative Analgesia: An Observational Clinical Study

“…21 In the present study, addition of clonidine toropivacaine was found to be effective in providing effective intraoperative and postoperative analgesia. Respiratory depression is an expected but unwanted side effect of extradural opioid; 22 it has also been noticed in adult patients whoreceived clonidine 300 mg extradurally. 23 Many previous studies have however not reported respiratory depression after caudal administration of clonidine 17,18,20,24 in pediatric patients.…”

Comparative Study Between Dexmedetomidine and Clonidine as an Adjunct to Bupivacaine in Brachial Plexus Block in Orthopaedic Surgeries

“…Clonidine has been widely used in all types of regional anaesthetic techniques. 4 Dexmedetomidine is a highly selective α 2 agonist with sedative and analgesic properties with minimal respiratory depression. It has a α 2 /α 1 selectivity ratio of (1600:1) which is eight times more potent than clonidine (200:1).…”