Comparative Evaluation of Efficacy of Caudal Bupivacaine Alone or in Combination With Butorphanol or Clonidine for Postoperative Analgesia in Children

Abstract

BACKGROUND: Addition of adjuvant in caudal block along with bupivacaine prolongs the duration of postoperative analgesia. AIMS: The aim of this study was to evaluate the efficacy of caudal bupivacaine alone or in combination with butorphanol or clonidine for postoperative analgesia in children undergoing infra-umbilical surgeries. MATERIAL AND METHODS: This study was a prospective, randomized, double blind study and seventy five children of ASA grade I and II of either sex aged 3-8yr were randomized to one of the three groups. Group A received 1 ml/kg of 0.25% bupivacaine; Group B received 20 µg/kg of butorphanol in combination with 1 ml/kg of 0.25% bupivacaine; and Group C received 2 µg/kg of clonidine in combination with 1 ml/kg of 0.25% bupivacaine caudally after general anaesthesia was induced. Hemodynamic variables (HR, SpO2, RR and NIBP) were monitored in all patients. Sedation score, mean duration of analgesia, modified objective pain score and requirement of rescue analgesia were recorded at preset time intervals along with various complications like nausea, vomiting, hypotension, bradycardia, respiratory depression, retention of urine, sweating, pruritis, hallucinations. STATISTYICAL ANALYSIS: ANOVA test (Analysis of variance) for intergroup comparison with parametric data, Student's paired t test for intragroup comparison, chi square test for non parametric data and complications and coefficient of variation for variation of parameters from the baseline. RESULTS: Mean duration of analgesia was maximum in group B (822.0±217.41 min) than in group A (383.2±81.04 min) and group C (745.4± 216.69 min) and it was statistically significant. The longer duration of sedation observed in group C was also statistically significant. No significant difference was observed in incidence of hemodynamic changes or side effects. CONCLUSION: Our results concluded that the addition of butorphanol and clonidine to bupivacaine resulted in superior analgesia with a longer duration of analgesia as compared to caudal bupivacaine alone. Moreover, addition of clonidine to bupivacaine resulted in a higher sedation score which is desirable in children.