Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

Abstract

Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. Conclusion We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects. Kathmandu University Medical Journal | VOL.10 | NO. 3 | ISSUE 39 | JUL- SEP 2012 | Page 25-29 DOI: http://dx.doi.org/10.3126/kumj.v10i3.8013

Comparative Evaluation of the Epidural Dexmedetomidine, Ketamine or Fentanyl in Combination With Bupivacaine in Dogs

“…These findings were in line with, Singh et al (2012) estimating that clonidine (an α 2 -agonist) in a dose of 1 µg kg −1 , added to 0.25% bupivacaine for caudal analgesia, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.25% bupivacaine in normal saline than 0.75 mL kg −1 of 0.25% bupivacaine with ketamine 0.5 mg kg −1 or 0.75 mL kg −1 of 0.25% bupivacaine with fentanyl 1 mcg kg −1 or 0.75 mL kg −1 of 0.25% bupivacaine alone, without any side effects. Saadawy et al (2009) as they concluded that caudal dexmedetomidine seems to be a promising adjunct to provide excellent analgesia without side effects over a 24 h period.…”

Comparing the effects of three different doses of caudal ketamine plus bupivacaine on pain control after paediatric surgery

“…Comparing the groups, the researchers found that the best analgesic effects had been observed in the second group, which were not consistent with the results of the study conducted by Fernandes et al Moreover, comparing the results of those investigations with the findings of our present study, it can be concluded that the dose of ketamine used in that study was equivalent to the one used in the present study, although the drugs and procedures employed in both studies were completely different. Moreover, the purpose of the present study was to obtain the effective dose of ketamine rather than comparing the effects of drugs with other ones [22].…”

Perbandingan Blokade Kaudal Bupivakain 0,25% dengan Kombinasi Bupivakain 0,25% dan Klonidin 1 µg/kgBB terhadap Waktu Kebutuhan Analgesik Pascaoperasi Hipospadia

“…6,10 Penelitian terdahulu juga menyatakan bahwa penambahan klonidin sebagai adjuvan blokade kaudal bupivakain menghasilkan waktu kebutuhan analgesik lebih panjang dan efek samping minimal dibanding dengan penambahan ketamin, fentanil, dan morfin. 11,12 Tujuan penelitian ini adalah mengetahui perbandingan blokade kaudal bupivakain dengan bupivakain klonidin terhadap waktu kebutuhan analgesik pascaoperasi hipospadia di RSUP Dr. Hasan Sadikin Bandung.…”

“…10,19 Penelitian ini konsisten dengan penelitianpenelitian yang pernah dilakukan sebelumnya, yaitu penambahan klonidin 1 µg/kgBB pada blokade kaudal bupivakain 0,25% secara signifikan meningkatkan waktu kebutuhan analgesik pada pediatrik setelah menjalani operasi elektif dibanding dengan bupivakain 0,25%. 6,10,20 Simpulan penelitian ini adalah blokade kaudal bupivakain 0,25% dan klonidin 1 µg/kgBB menunjukkan waktu kebutuhan analgesik yang lebih panjang dibanding dengan kelompok bupivakain 0,25%.…”