Abstract
IntroductionClonidine, a selective α2 adrenergic receptor agonist, combined with caudally administered bupivacaine, is frequently used in children to prolong the duration of postoperative analgesia following infraumbilical surgery. On the other hand, dexmedetomidine is highly selective and has a greater affinity toward α2 adrenergic receptors, especially toward its α2a subtype, accountable for more analgesic and hypnotic effects than clonidine.Aims and objectivesWe designed a prospective, double-blinded, randomized controlled trial to compare the analgesic efficacy and adverse effects of clonidine and dexmedetomidine when combined with bupivacaine for caudal analgesia in children undergoing infraumbilical surgeries.Materials and methodsA total of 60 children aged one to eight years were randomly assigned into two different groups in a double-blinded manner. Following induction of general anesthesia, every patient received a single dose of caudal bupivacaine 0.25% (0.75 ml/kg) mixed with either clonidine (1 µ/kg) in normal saline or dexmedetomidine (1 µ/kg) in normal saline. We noted the hemodynamic variables and postoperative sedation scores. Duration and quality of postoperative analgesia and the number of rescue analgesic drug doses required were recorded during the first 24 hours postoperatively. We also observed the patients for any adverse effects to the study drugs.ResultAdding dexmedetomidine to caudally administered bupivacaine significantly increased the duration of analgesia (15 ± 0.78 hours) and decreased the need for rescue drug doses than the addition of clonidine to bupivacaine (9.63 ± 1.95 hours) in children undergoing infraumbilical surgeries. Incidences of hemodynamic changes or other side effects were comparable between patients of two groups.ConclusionThe addition of dexmedetomidine to caudally administered bupivacaine in children undergoing infraumbilical surgeries may provide a longer duration of analgesia than the addition of clonidine, with less requirement of rescue analgesic doses and without any significant differences in the hemodynamic parameters or other side effects.
Highlights
MethodsA total of 60 children aged one to eight years were randomly assigned into two different groups in a doubleblinded manner
Clonidine, a selective α2 adrenergic receptor agonist, combined with caudally administered bupivacaine, is frequently used in children to prolong the duration of postoperative analgesia following infraumbilical surgery
We found that the duration of caudal analgesia was significantly higher in the group receiving bupivacainedexmedetomidine (15 ± 0.78 hours) than the group receiving bupivacaine-clonidine (9.63 ± 1.95 hours)
Summary
A total of 60 children aged one to eight years were randomly assigned into two different groups in a doubleblinded manner. Following induction of general anesthesia, every patient received a single dose of caudal bupivacaine 0.25% (0.75 ml/kg) mixed with either clonidine (1 μ/kg) in normal saline or dexmedetomidine (1 μ/kg) in normal saline. We excluded children whose parents/guardians refused to give consent; children with a history of allergy to study drugs; those with bleeding or coagulation disorder or developmental delay; and those with evidence of infection over the lower back or anatomical malformation at the puncture site. We randomly assigned the patients into groups using computer-generated random numbers. We placed the children in the left semi-prone position and a senior anesthesiologist performed a single-shot caudal epidural block using a 23 G hypodermic needle under aseptic conditions. Needle placement in the caudal space was confirmed using the loss of resistance technique
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