Abstract
Objective: Spinal anaesthesia (SA) is a well-established technique for infra-umbilical surgeries but is underutilized in children. One important reason is the limited duration of action. Clonidine is a useful adjuvant in this regard but has not been studied in a dose of 1.5 μg/kg.Design: a prospective randomized study
 Setting: A single centre study conducted at a Super speciality paediatric tertiary care centre.Participants: Sixty children (5-12yrs) scheduled for lower abdominal surgery with duration <90min were included.Interventions: The participants were randomized into two groups to receive 0.4mg/kg of 0.5% hyperbaric bupivacaine with clonidine 1.5μg/kg (Group-I, n=30) or 0.4mg/kg of 0.5% hyperbaric bupivacaine with saline(Group-II, n=30) in the subarachnoid block.Main outcome measures: The sensory and motor block duration, time to two-segment regression, time to first rescue analgesic, and the number of rescue doses required were recorded.Results: Mean duration of sensory blockade (147.5±7.28 vs 310.33±10.17min; P<0.001) and motor blockade (132.5±10.06 vs 283.33±11.77min; P < 0.001) and duration of analgesia (172±9.61 vs 364.50±28.75min; P < 0.001) were significantly prolonged in the clonidine group. In the control group, most patients needed three analgesic doses over 24hr while in the clonidine group, the majority needed two doses. Adverse effects were infrequent in both groups.Conclusions: Clonidine as an adjuvant to 0.5% hyperbaric bupivacaine significantly prolonged the duration of analgesia with improved quality of anaesthesia while maintaining safety. We recommend the routine use of clonidine 1.5 μg/kg dose as an adjuvant to 0.5% bupivacaine in paediatric SA.
Highlights
The history of paediatric spinal anaesthesia (SA) dates back to 1898 when August Bier injected cocaine intrathecally in an 11-year-old child for surgery of thigh tumour and paved the way for this valuable technique in the field of paediatric anaesthesia.[1]
The sole use of SA has been considered as a standard of care for sick ex-premature neonates and infants who are
The present study demonstrated that the use of clonidine in a dose of 1.5 μg/kg when added to hyperbaric bupivacaine intrathecally, resulted in a statistically significant increase in the duration of sensory and motor block as well as effective postoperative analgesia when compared to bupivacaine alone
Summary
The history of paediatric spinal anaesthesia (SA) dates back to 1898 when August Bier injected cocaine intrathecally in an 11-year-old child for surgery of thigh tumour and paved the way for this valuable technique in the field of paediatric anaesthesia.[1] Ever since, it gained considerable interest and significance. Even after a substantial safety record of over a century, the role of spinal anaesthesia (SA) as a primary anaesthetic technique in children remains an anathema. It is confined to only a few specialized paediatric centres globally. There is ample literature to suggest its safety and efficacy for suitable procedures in older children as well.[4,5] The sole use of SA has been considered as a standard of care for sick ex-premature neonates and infants who are
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