Effect of caudal clonidine on emergence agitation and postoperative analgesia after sevoflurane anaesthesia in children: Randomised comparison of two doses

Abstract

Background and Aims:Sevoflurane, a popular inhalational anaesthetic for children, has been associated with significant emergence agitation in the recovery phase. This study was intended to compare two doses of caudal clonidine added to ropivacaine 0.2% in order to decide on the optimal dose for prevention of sevoflurane induced emergence agitation (EA) and to get a meaningful prolongation of postoperative analgesia with minimal side effects.Methods:Sixty-one children aged 1–7 years (American Society of Anaesthesiologists physical status I-II) received standardized general anaesthesia with inhaled sevoflurane and caudal epidural block with 0.2% ropivacaine 1 ml/kg for sub-umbilical surgeries. They were assigned randomly to two groups: (I) clonidine 1 μg/kg added to caudal ropivacaine; (II) clonidine 2 μg/kg added to caudal ropivacaine. EA and postoperative analgesia were assessed using pain/discomfort scale score and face, legs, activity, cry, consolability (FLACC) score respectively.Results:EA was observed in 8 children (26.6%) in group I when compared to only 2 children (6.4%) in group II after first 15 min postoperatively. Incidences of EA at 15 min, as well as total incidence of agitation, were both significantly lower in group II when compared to group I with P < 0.05. Duration of analgesia in group I (12 [8–20] h) and group II (16 [8–20] h) was statistically comparable (P > 0.05). There was no difference in the incidence of sedation or complications.Conclusion:Caudal clonidine 2 μg/kg added to 0.2% ropivacaine 1 ml/kg is suggested to be the optimal dose, for prevention of EA and meaningful prolongation of postoperative analgesia with minimal side-effects.

Effect of caudally administered clonidine on sevoflurane induced emergence agitation—A randomized trial

“…reported clonidine as an effective caudal adjuvant with ropivacaine in a dose of two mcg/kg for prevention of EA. [ 2 ]Hence we used clonidine in a dose of 2 mcg/kg and preferred the caudal route of administration to give the patients the added benefit of better analgesic effect compared to intravenous route as was demonstrated in the study by Bock et al . [ 1 ]…”

“…where they compared two different doses of clonidine- 1mcg/kg and 2mcg/kg given caudally with 0.2% ropivacaine and found that clonidine 2mcg/kg had lesser incidence of EA and also provided longer duration of analgesia. [ 2 ]…”

“…Though the rapid and smooth induction due to lower blood/gas partition co-efficient and low irritation to airways is impressive on one hand, the equally rapid awakening from anesthesia is also a cause for worry since it results in post anesthetic emergence agitation (EA). [ 1 2 ] EA is a significant problem in children recovering from anesthesia with a reported incidence of 10-80%[ 3 4 5 6 ] and manifests as restlessness, disorientation, crying, excitation, and agitation during emergence and may cause injury to the child, disruption of the surgical site and dressing, drains, or even removal of intravenous catheters. This necessitates extra nursing care and supplemental sedation and/or analgesics, which may delay discharge from hospital.…”

A comparison of dexamethasone and clonidine as an adjuvant for caudal blocks in pediatric urogenital surgeries

“…Clonidine has been used at various doses caudally: 1–5 µg/kg. We chose a dose of 1 µg/kg as it is associated with longer duration of analgesia[ 26 27 ] and less postoperative emergence agitation. The dose of dexamethasone was chosen based on a study done earlier by Kim et al .…”