Background: Caudal analgesia has long been the cornerstone to successful pain management in children undergoing abdominal and lower limb surgeries. Its analgesic duration with single shot injection is however limited. So adjuvants are used with local anesthetics in an attempt to increase the duration of caudal analgesia. This study aims to investigate the duration of analgesia provided by Clonidine when added to caudal Bupivacaine.Methods: A randomized, double blinded, comparative study was conducted on 64 patients, aged two to seven years, scheduled for unilateral inguinal hernia repair. Patients were randomly allocated into two groups of 32 each, with group A receiving bupivacaine two milligram/kilogram and group B receiving bupivacaine two milligram/kilogram with one microgram/kilogramclonidine, (total volume of injectate was one milliliter/kilogram). Duration of analgesia, hemodynamic response and adverse effects, if any were noted.Results: Mean duration of analgesia in group A was 264.12 ± 68.77 minutes and in group B was 520 ± 57.37 minutes, p-value <0.001.Incidence of vomiting was 9% in group A compared to 6% in group B.Conclusions: Clonidineas an adjuvant to caudal bupivacaine prolongs the duration of analgesia without increasing the adverse effects.Keywords: Bupivacaine; caudal analgesia; clonidine;pediatric.

Background: The goal of postoperative analgesia is to minimise pain with least possible side effects and in our setting be as cost effective as possible. In children, caudal anaesthesia is typically combined with general anaesthesia for intraoperative and postoperative analgesia. Adjuvants can be added to local anaesthetics for prolonging the duration of analgesia. This study was done to find out the duration of analgesia of caudal Bupivacaine in combination with Tramadol.Methods: This prospective, randomised, double-blind, comparative study was done by taking a total of 60 patients, aged between 2 to 7 years undergoing elective lower abdominal, urological and lower extremity surgeries. The patients were randomized to group A (n=30) receiving 1 ml/kg of 0.25% bupivacaine and group B (n=30) receiving 1 ml/kg of 0.25% bupivacaine plus 1mg/kg of tramadol caudally. Duration of analgesia, hemodynamic responses and adverse effects were noted and analysed.Results: Thirty patients in both groups were comparable with regard to demographic data and hemodynamic response and were statistically non-significant (P>0.05). It was observed that the mean duration of analgesia was significantly longer in group B (467.5±164.5 min versus 240.5±69.4 min, P<0.001). One patient in each group had postoperative vomiting.Conclusion: Tramadol 1mg/kg as an adjuvant to bupivacaine 0.25% for caudal analgesia in children is effective in increasing the duration of analgesia without an increase of adverse effects.

Background: I-gel, the novel Supraglottic airway device, is easier to insert, has improved stability after insertion with reduced tissue compression.The study aims to compare the efficacy of I-gel with classic Laryngeal Mask Airway in the paediatric population.Methods: A randomised parallel group study was done in Department of Anesthesiology, Kanti Children Hospital, Kathmandu for a period of three months. I gel and classic LMA was compared based on leak airway pressure, time of insertion and ease of insertion.Results: Age and weight are comparable among groups. Compared to cLMA, I-gel provides a better leak pressure seal (16.40+-3.42 vs. 23.11+- 6.17 cm of H2O, p 0.027), faster time of insertion (19.42+-4.40 vs. 29.84+-7.70 seconds, p-0.02) and similar ease of insertion (p-0.571).Conclusions: I-gel compared to classic Laryngeal Mask Airway provides better resistance to leak airway pressure, faster time of insertion with comparable ease of insertion.