Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally

Abstract

The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications. Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (P<0.05). Side effects such as respiratory depression, vomiting and bradycardia were similar in both groups. The adjunction of clonidine to fentanyl as additives to bupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

“…Two studies evaluated the efficacy of caudal epidural anesthesia on postoperative analgesia in children undergoing orchiopexy and inguinal hernia repair. 30 , 40 One study evaluated three different volumes of 0.25% levobupivacaine (low: 0.6 mL/kg; middle: 0.8 mL/kg; and high: 1.0 mL/ kg) and reported that the postoperative analgesic consumption at 6, 12, and 24 hours following surgery did not differ among groups. The postoperative pain was evaluated using the CHIPPS instrument which was not statistically different among groups at any time period.…”

Predictors of perioperative respiratory adverse events among children with upper respiratory tract infection undergoing pediatric ambulatory ilioinguinal surgery: a prospective observational research

“…23 The main limitations of this observational study were that we focused only on the assessment of the risk factors for PRAEs in children undergoing ambulatory surgery, and we did not investigate the repeatability and reproducibility of COLDS scoring, in addition to the lack of blinding. The second limitation was that we did not study the role of our anesthetic protocol, 24 which did not include regional analgesic techniques, 25 in increasing the risk of PRAEs, as we used the same protocol for all patients.…”

The safety of a mixture of bupivacaine and lidocaine in children after urologic inguinal and scrotal surgery

“…Many tools use both physiological and behavioral measures to determine pain scores [ 11 ]. Local anesthesia is a simple-to-use technique for post-operative pain management [ 2 ]. Toxicity of local anesthetics is mostly attributable to high plasma concentrations of such agents [ 12 ].…”

“…In pediatric patients, local anesthesia is commonly used, as it is a reliable, safe, and easy method of pain control. Therefore, it is common to inject local anesthetics at the end of surgery to relive postoperative pain [ 2 ]. Lidocaine is often used as local anesthesia because it is associated with a fast onset of sensory blockade and good efficacy.…”

“…The former quickly blocks sensations, and the latter blocks the senses for a long time, so they are mixed to take advantage of both [ 3 ]. The onset of action of bupivacaine is 5 to 10 minutes and it has a duration of effect of up to six hours [ 2 ].…”