Title: Comparison of Post-Operative Analgesia after Single Shot Caudal Epidural Block Using Ropivacaine with or without Clonidine in Children

Author: Dr Shobha Namdeo Pore

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.51

Abstract

Caudal epidural block is one of the most common regional anesthetic techniques in children being used to supplement general anesthesia for a wide variety of surgeries. The local anesthetics currently in use are safe and their pharmacological effects have been well evaluated. The aim of this study is to clinically evaluate the efficacy of caudal epidural clonidine in prolonging the post-operative analgesia when mixed with ropivacaine in children and to compare the post-operative pain-free duration and the side effects of ropivacaine with or without Clonidine. The addition of α-2 agonist, Clonidine to local anesthetic solution 0.2% ropivacaine has been shown to enhance the duration and quality of central and peripheral nerve blocks. The main advantage of Clonidine (versus opioids) is the negligible risk of respiratory depression.

Keywords: Caudal epidural, post-operative analgesia, ropivacaine, Clonidine.

References

  1. Choonara I. Pain relief. Arch Disease child 1989; 64: 1101-1102.
  2. M S Batra. Regional anesthesia in ambulatory surgery: contemporary issues In G P Dureja, R Madan, H L Kaul editors, Regional anesthesia and Pain management. B I Churchill Livingstone. Chapter 40; 304-309.
  3. Kundra P, Deepalakshmi K, Ravi Shankar M. Pre-emptive caudal Bupivacaine and Morphine for postoperative analgesia in children. AnesthAnalg 1998; 87: 52-60.
  4. Kelly D, Young .Pediatric procedural pain. Ann Emerg med 2005; 45 (2): 160-171.
  5. Lonnqvist PA, Ivani G, Moriarty T. Use of caudal-epidural opiods in children: still state of the art or the beginning of the end? PaediatrAnaesth 2002; 12: 747
  6. Abdulatif M, El-Sanabary M. Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. Anaesthanalg 2002; 95: 1215
  7. Ravi Berde, Neelesh Nema, Bhuvneswar Minj, Mahendra Mujalde, Nandkishore, Amit, Nidhi. “Comparative Study of Caudal Ropivacaine and Ropivacaine-Clonidine Combination in Pediatric Urogenital Surgeries for Post-Operative Analgesia”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 60, July 27; Page: 10477-10487, DOI: 10.14260/jemds/2015/1510
  8. Klimscha W, Chiari A, Michalek-Sauberer A, Wildling E, Lerche A, Lorber C. The efficacy and safety of a clonidine/bupivacaine combination in caudal blockade for pediatric hernia repair. AnesthAnalg. 1998;86:54–61. [PubMed]
  9. Breschan C, Krumpholz R, Likar R, Kraschl R, Schalk HV. Can a dose of 2 mcg/kg caudal clonidine cause respiratory depression in neonates? PaediatrAnaesth. 1999;9:81–3. [PubMed]
  10. Eisenach JC, De Kock M, Klimscha W. Alpha(2)- adrenergic agonist for regional anesthesia: A clinical review of clonidine (1984-1995) Anesthesiology. 1996;85:655–74. [PubMed]
  11. Jamali S, Monin S, Begon C, Dubousset AM, Ecoffey C. Clonidine in pediatric caudal anaesthesia. AnesthAnalg. 1994;78:663–6. [PubMed]
  12. Lee JJ, Rubin AP. Comparison of a bupivacaine-clonidine mixture with plain bupivacaine for caudal analgesia in children. Br J Anaesth. 1994;72:258–62. [PubMed]
  13. Motsch J, Böttiger BW, Bach A, Böhrer H, Skoberne T, Martin E. Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in children. ActaAnaesthesiol Scand. 1997;41:877–83. [PubMed]
  14. (Eisenach J, Detweiter D, Hood D. Haemodynamic and analgesicaction of epidurally administered clonidine. Anesthesiology 1993;78:277-87.)
  15. Joshi W, Connelly NR, Freeman K, Reuben SS. Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade. PaediatrAnaesth. 2004;14:483–6. [PubMed]
  16. Kimo K, Lundin S, Elam M. Epidural clonidine depresses the sympathetic nervous activity in humans by a supraspinal mechanism. Anesthesiology 1993; 78: 1021-1027
  17. Gentili and F Bonnet. Incidence of urinary retention after spinal anesthesia. Comparison of morphine and clonidine (abstract). Anesthesiology 1994; 81: A945.

Corresponding Author

Dr Shobha Namdeo Pore

Senior Resident, Department of Anesthesiology, Government Medical College Miraj, Maharashtra, India

Plot No-15Shivparvati Nagar, Link Road, Pandharpur, Dist.: Solapur

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.