Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children

Disma, Nicola; Frawley, Geoff; Mameli, Leila; Pistorio, Angela; Alberighi, Ornella Della Casa; Montobbio, Giovanni; Tuo, Pietro

doi:10.1111/j.1460-9592.2010.03478.x

Cited by 28 publications

(32 citation statements)

References 39 publications

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“…15 As an oral premedicant, higher doses of clonidine (4lg/kg) were associated with less postoperative nausea and vomiting after surgery for strabismus. 16 For SEMLS, multiple dermatomes (L1-S2) must be blocked to attain satisfactory epidural analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…7,14 The minimum local anaesthetic concentration of levobupivacaine for caudal epidural block in children decreases in a dose-dependent manner and the duration of effect prolonged, with increasing dose of added clonidine. 15 As an oral premedicant, higher doses of clonidine (4lg/kg) were associated with less postoperative nausea and vomiting after surgery for strabismus. 16 For SEMLS, multiple dermatomes (L1-S2) must be blocked to attain satisfactory epidural analgesia.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Chalkiadis

Sommerfield

Low

et al. 2015

Develop Med Child Neuro

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AUCArea under the curve SEMLS Single-event multilevel surgery AIM To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery.METHOD Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]).RESULTS There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001).INTERPRETATION Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile.Cerebral palsy (CP) by definition is a disorder of movement and posture, caused by a non-progressive brain injury or lesion. 1 However, although the causative brain lesion is defined as a static encephalopathy, the musculoskeletal pathology in the limbs is progressive during the child's growth and maturation, with the development of contractures, bony torsion, and joint instability. Children with CP may undergo extensive orthopaedic surgery of the lower extremities to correct deformity and improve function. Single-event multilevel surgery (SEMLS), defined as at least one surgical procedure, performed on two different anatomical levels (hip, knee, or ankles), has been shown to result in dramatic improvements in gait and functioning, which are sustained at 5-year follow-up and reduce the need for serial surgeries and periods of rehabilitation. 2,3 Good pain control is important for patient comfort and facilitates early rehabilitation and discharge. Effective pain management is challenging because of multiple surgical incisions, associated comorbidities (chronic lung disease, risk of aspiration, epilepsy, gastro-oesophageal reflux), and impairments in communication and/or cognition that may make pain assessment difficult. In addition, the surgical nociceptive input is likely to lead to wind-up of spinal reflexes and worsening of muscle spasm 4 and possibly to an escalating pain-spasm cycle. Epidural analgesia is the preferred modality of regional anaesthesia in our institution but there are limited data...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Chalkiadis

Sommerfield

Low

et al. 2015

Develop Med Child Neuro

View full text Add to dashboard Cite

show abstract

“…Other studies by Gupta also showed a significant prolongation of duration of analgesia in their respective studies when clonidine was used as an adjuvant to local anaesthetics in epidural administration. Disma N et al 19 showed that a dose of 2μg/kg of clonidine increases the duration of post-operative analgesia in caudal anaesthesia for lower abdominal surgery. Clonidine produces analgesia by blocking the conduction of C and Aδ fibers and increasing potassium conductance in isolated neurons in vitro and thereby intensifying conduction block of local anaesthetics.…”

Section: Discussionmentioning

confidence: 99%

“…While the clonidine group showed a greater fall in systolic and diastolic blood pressure compared to the control group this change was statistically insignificant. Similarly the studies conducted by Ghatak T et al 19 and Alves TCA and Braz JRC 17 showed no significant decrease in blood pressure between the clonidine and the control groups in their respective studies.…”

mentioning

confidence: 89%

Epidural levobupivacaine with clonidine prolongs anaesthesia and analgesia

Arumugam

Tandon

Choudhary

2016

Sri Lankan J Anaesthesiol

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Background: Epidural anaesthesia is a safe alternative for general anaesthesia in patients undergoing infraumbilical surgeries. This study was conducted to evaluate the effect of clonidine as an adjuvant to levobupivacaine, an S (-) enantiomer of bupivacaine. Material and Methods:Hundred patients of ASA grade I and II undergoing infraumbilical surgeries were randomized in two groups as L and LC. Group L received 0.5% levobupivacaine (1.5mg/kg) and group LC received 0.5% levobupivacaine (1.5mg/kg) with clonidine (2µg/kg). The onset time for sensory, motor blockade, duration of anaesthesia and duration of analgesia, VAS score were observed in both the groups. The haemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate and SPO2 at various time intervals were measured. Any untoward side effects were noted in both groups. Results:The onset of sensory (7.8±1.7mins) and motor blockade (10.9±1.9mins) was significantly faster in clonidine group. Duration of anaesthesia and duration of analgesia was prolonged in group LC (234.5±16.1mins, 412.8±48.3mins) compared to group L (173.56±12.78 min, 269.2±24.2mins) which was statistically significant (p<0.05). Similarly clonidine group had less VAS score compared to control group. There was no significant change in the haemodynamic variables between the two groups. Hypotension and bradycardia was found more in clonidine group compared to the control group. Conclusion:Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anaesthesia for infraumbilical surgeries.

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“…In addition, there was a dose dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 µg kg of clonidine provides the optimum balance between improved analgesia and minimal side effects [10] .…”

Section: Discussionmentioning

confidence: 99%

A Study of Clonidine and Dexmedetomidine as Adjuvant to Epidural Levobupivacaine for Post Operative Analgesia in Infraumbilical Surgeries

Acharya¹

2017

jmscr

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Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children

Cited by 28 publications

References 39 publications

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Epidural levobupivacaine with clonidine prolongs anaesthesia and analgesia

A Study of Clonidine and Dexmedetomidine as Adjuvant to Epidural Levobupivacaine for Post Operative Analgesia in Infraumbilical Surgeries

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