Efficacy of Clonidine as an Adjuvant to Bupivacaine for Caudal Block in Children Undergoing Infra - Umbilical Surgery

Abstract

Caudal epidural analgesia with bupivacaine is common in paediatric anaesthesia for providing intra and postoperative analgesia. But duration of analgesia even with bupivacaine; long acting anaesthetic is short only 4-6hrs. Hence, several adjuvants have been tried to prolong the duration of action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesic effect provided by caudal bupivacaine in children undergoing infraumbilical surgery. Forty children, aged one to seven years, American Society of Anaesthesiologists (ASA) Grade I/II, undergoing infra-umbilical surgery, were included in prospective randomized double blind study to one of two groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group A) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with 1 µg/kg of clonidine in normal saline (Group B). Post-operative pain was assessed for 24 hours using the Objective Pain Scale (OPS). The mean duration of analgesia was significantly longer in Group B (10.2 Hrs.) than in Group A (4.2 1Hrs); P<0.05, which was statistically significant. In both the groups, there were no significant changes in the heart rate and mean arterial pressure from the baseline value, in the intraoperative as well as postoperative period (p>0.05). The requirement of rescue medicine was lesser in Group B. Clonidine as an adjunct to bupivacaine prolongs the post-operative pain relief in children and is safe compared to bupivacaine alone in paediatric infra umbilical surgeries.