Title: Comparative Study of Plain Bupivacaine and Bupivacaine with Clonidine for Caudal Epidural in Paediatric Patients
Authors: Dr Shweta Mehta, Dr Jigisha Makwana
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.72
Abstract
Aims and Objectives: To compare perioperative haemodynamic changes and complications, the quality and duration of post operative analgesia, total number of rescue analgesic doses required and degree and duration of sedation post operatively in each group.
Material and Method:70 children of ASA grade I or II aged 5-10 years, undergoing elective infraumbilical surgies were randomly allocated to group A(n=35)(0.25% plain bupivacaine 1 ml/kg+1 ml normal saline) and group B(n=35)(0.25% bupivacaine 1 ml/kg + clonidine 1mcg/kg in 1 ml normal saline). Post operative pain scores, duration of analgesia, total number of rescue analgesic doses required, haemodynamic changes, perioperative complications and degree and duration of sedation were recorded. Pain score was assessed using OPS score,
Results: The mean duration of analgesia in postoperative period was more in group B(9.20 ±0.76) hours as compared to Group A (4.9 ± 1.23) hours ;P<0.05.The children in group B had lower pain scores as compared to group A which was statistically significant. 100% patients in group A required two or more than two doses of rescue analgesic whereas in group B 85% patients required single dose of rescue analgesic and 12% patients required two doses of rescue analgesic in first 12 hours post operatively. Mean sedation scores were higher in group B as compared to group A
Conclusion: Addition of clonidine (1 mcg/kg) to bupicaine (0.25% 1 ml/kg) to caudal epidural block prolongs the duration of analgesia in paediatric patients.
Keyword: Paediatric patients, caudal epidural block, bupicaine and clonidine, postoperative analgesia.
1. 1. Koul A,Pant D, Sood J:"Caudal clonidine in day-care paediatric surgery."Indian Jou-rnal of Anaesthesia 2009;53(4):450-454.
2. Parameswari A,Dhev A,Vakamudi M:"Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in paediatric patients undergoing sub-umbilical surgery."Indian Journal of Anaesthesia 2010; Sept-Oct 54(5):458-463.
3. De Beer DA,Thomas ML:"Caudal additivees in paediatric patients-solutions or problems?."Br J Anaesth 2003; 90(4): 487-98.
4. El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. "Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in paediatric patients." Br J Anaesth. 2009 Aug;103(2):268-74. doi: 10.1093/bja/aep159. Epub 2009 Jun 18. ;
5. Hager H ,Marhofer P,Sitzwohl C,Adler L,Kettner S,Semsroth M:"Caudal clonidine prolongs analgesia from caudal S(+) ketamine in paediatric patients. Anaesth Analg 2002 May;94(5):1169-72.
6. Joshi W, Connelly NR, Freeman K, Reuben SS:"Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade."PaediatrAnaesth 2004 Jun;14(6):483-6.
7. Singh J, Shah RS, Vaidya N, Mahato PK, Shrestha S, Shrestha BL:"Comparison of ketamine, fentanyl and clonidine as an adjuvant during bupivacaine caudal anaesthesia in paediatric patients." Kathmandu Univ Med J (KUMJ). 2012 Jul-Sep;10(39):25-9. ;
8. Adate KU, Sardesai S, Thombre SK, Shinde AJ:"Comparison of two different concentration of ropivacaine with clonidine as adjuvant in caudal epidural in paediatric patients."The internet journal of Anaesthesiology,2011 Volume 28 Number1.
9. Upadhyay L, K.K DrBrig,. Prabhakar T:"Study of the efficacy and safety of clonidine as an adjuvant to bupivacaine for caudal analgesia in paediatric patients. Indian J Anaesth.2005;49(3):199-201
10. Murat I, Montay G, Delleur MM, Esteve C,Saint-Maurice C:"Bupivacaine pharma-cokinetics during epiduaral anaesthesia in paediatric patients. "Eur J Anaesthesiol. 1988;5:113-20.
11. Singh R,Kumar N,Singh P:"Randomized controlled trial comparing morphine or clonidine with bupivacaine for caudal analgesia in paediatric patients undergoing upper abdominal surgery. "Br.J. Anaesth .(2011)106(1):96-100.
12. Sharpe P,Klein JR,Thompson JP,Rushman SC,Sherwin J,Wandless JG,Fell D. "Analgesia for circumcision in a paediatric population: Comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine."Paediatr Anaesth 2001 Nov,11(6):695-700.
13. Tripi PA,Palmer JS,Thomas S,Elder JS." Clonidine increases duration of bupiva-caine caudal analgesia for ureteroneocyst-ostomy:a double-blind prospective trial."J urol.2005 Sept;174(3):1081-3.
14. Shukla U,Prabhakar T,Malhotra K." Postoperative analgesia in paediatric pati-ents when using clonidine or fentanyl with ropivacaine given caudally."J Anaesthesiol ClinP harmacol 2011;27:205-10.
15. Yildiz TS, Korkmaz F, Solak M,Toke rK."Clonidine addition prolongs the duration of caudal analgesia. "Acta AnaesthesiolSc and 2006 Apr;50(4):501-4.
16. J J Lee et al, A.P.Rubin et al:"Comparison of a bupivacaine –clonidine mixture with plain bupivacaine for caudal analgesia in paediatric patients."British Journal of Anaessia 1994;72:28-262
17. Klimscha W, Chiari A, Michalek S A, Wildling E, Lerche A, Lorber C, Semsroth M :"The efficacy and safety of a clonidine/ bupivacaine combination in caudal blockade for paediatric hernia repair.: AnaesthAnalg 1998 Jan;86(1):54-61.
18. Motsch J, Bottiger BW, Bacha, Bohrer H, Skoberne T, Martin E."Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in paediatric patients."Acta Anaesthesiol Scand.1997 Aug;41(7):877-83.