Controlled comparison of ropivacaine with dexmedetomidine, clonidine and magnesium sulphate as adjuvant in caudal epidural block in paediatric population for infra-umbilical surgeries

Abstract

Caudal analgesia and anaesthesia is one of the safest and widely used methods for pain relief in paediatric population. Aim of this study is to compare the efficacy of dexmedetomidine, clonidine, magnesium sulphate as adjuvants to 0.25% ropivacaine in caudal anaesthesia for enhancement of duration of analgesia as well as to determine safety of the blockade in paediatric population. It is prospective, randomised, double-blinded study in which eighty children (2–8 years), belonging to American society of Anesthesiologists physical status I and II scheduled for infra-umbilical surgeries were randomised into four groups namely: group R; Inj. Ropivacaine 0.25%, Group D; inj.ropivacaine 0.25% with adjuvant dexmedetomidine 0.5 μg/kg, Group C; inj.ropivacaine 0.25% with clonidine 1 μg /kgs, group M; inj.ropivacaine 0.25% with magnesium sulphate 50 mgs. The primary outcomes of study were time to onset of block and duration of analgesia. The secondary outcome was to study haemodynamic stability and adverse effects. Duration of analgesia was significantly longer (f=855.4778 and p<0.0001) in adjuvant groups as compared to control group and was statistically significant (p = 0.0001 and 0.0411 respectively). No significant difference was observed in the incidence of haemodynamic changes or side effects. Addition of above-mentioned drugs as adjuvants to 0.25% ropivacaine in caudal block significantly prolonged the duration of post‑operative analgesia with least effect on haemodynamic profile or any other significant adverse effects.