Introduction: The efficacy of clonidine or fentanyl as additives to alter the neuroendocrine stress response and emergence agitation in caudal anaesthesia in children is still not clear. Objectives: To compare the efficacy and safety of Fentanyl and Clonidine as additives to plain bupivacaine in caudal anaesthesia in children. Materials & Methods: A prospective, open labeled randomized controlled trial was conducted in Meenakshi Mission Hospital and Research Centre, Madurai, between August 2008 to June 2010. Children undergoing various elective infra-umbilical surgical procedures were included. Children were randomly assigned to either 0.5% Bupivacaine(B), Fentanyl plus 0.5% Bupivacaine (BF) or Clonidine Plus 0.5% Bupivacaine (BC) groups. Results: A total of 90 children, with 30 subjects in each of the three intervention groups were included. Time taken for spontaneous movement was significantly higher (151.8±11.7) in BC group, as compared the other two groups. The duration of postoperative analgesia was lowest in Bupivacaine (146±91.2) alone group, followed by BF (293.5±154.5) and BC group (510±359.9). Sedation time also has shown a similar trend. The mean pain scores from 2 hours to 24 hours were highest in bupivacaine group, followed by BF and BC group. The differences in the sedation scores across the three study groups from 45minutes to 24-hour postoperative period were statistically significant. Conclusions: Addition of clonidine 1µg/kg to 0.5% bupivacaine prolonged the duration of postoperative analgesia after a single shot caudal injection without any significant side effects when compared to bupivacaine 0.5% alone or its combination with fentanyl 1µg/kg.

Background: The present study was conducted to compare the efficacy and safety of intravenous dexmedetomidine and midazolam on prolongation of spinal anesthesia.Methods: The study population included people who were undergoing for spinal anesthesia for various surgeries. A total of 90 subject were randomized equally to Dexmedetomidine, Midazolam and saline groups using a computer generated random number sequence. Three study groups were compared with respect to all the baseline variables. The key outcome parameters and hemodynamic parameters were compared among the three study groups.Results: No statistically significant differences were observed in baseline paramters across study groups. The median values of patient satisfaction score and anesthesiologist satisfaction score were almost equal among three study groups, but the association was statistically not significant. The median VAS and the median HSL were slightly lower in dexmedetomidine group than other two groups (VAS-1,2,3 respectively and HSL -4,6,6 respectively) with statistically significant association (P<0.001). The proportion of Bradycardia and hypertension was slightly higher(13.3%) in dexmedetomidine group than other two groups whereas patients with excessive sedation 16.7% in midazolam group. The proportion of patients requiring analgesic for the first 24 hours was 36.7% in saline group, 33.33% in midazolam group. The association between symptoms and study groups was statistically not significant (P value>0.05) except with number of patients requiring analgesic for the first 24 hours (P value<0.05).Conclusions: Measurement of patient and anesthesiologist satisfaction scores are more or less similar in midazolam and dexmedetomidine groups compare to saline group.