English

Abstract

BACKGROUND: Caudal epidural block is one of the most popularly used regional techniques in paediatric patients. Various drugs in different concentrations have been used for the technique. Local anaesthetic like Ropivacaine produces differential neuraxial blockade with less motor block and reduced cardiovascular toxicity. To increase the duration of action of local anaesthetics and thereby analgesia extending to the post-operative period, various adjuvants like clonidine an α2 agonist has been used. Post-operative pain is the main concern in circumcision. Lower concentration of local anaesthetics can be used for the procedure as motor blockade is not required. Hence we have compared Bupivacaine 0.25% combined with 1µg/kg of clonidine and Ropivacaine 0.25% combined with 1µg/kg clonidine at a volume of 0.5ml/kg in children undergoing circumcision. AIMS AND OBJECTIVES: To assess the safety, efficacy, onset and duration of analgesia of 0.25% Bupivacaine and 0.25% Ropivacaine when equal volumes of Clonidine is added as an adjuvant in paediatric caudal block. MATERIAL AND METHODS: The Current Study is a comparative randomized study where sampling method was purposive sampling. Statistical analysis was done using student's t test and chi square test. 60 children aged between 1 to 6 years weighing < 20 Kgs posted for circumcision were divided into two groups of 30 each. GROUP I received 0.25% Bupivacaine 0.5ml/kg + 1μg/kg Clonidine and GROUP II received 0.25% Ropivacaine 0.5ml/kg + 1μg/kg Clonidine. Intra-operatively, onset of analgesia was noted. Post-operatively, duration of analgesia was assessed using the observational pain scale, duration of sedation was assessed using sedation score and the duration of motor block was assessed using modified bromage scale. RESULTS: The onset of action in Group I (Bupivacaine) and II (Ropivacaine) was 7.06±0.69mins and 6.5±0.73mins respectively. The duration of analgesia was 477.5±39.01mins in group I (Bupivacaine) and 437±23.21mins in group II (Ropivacaine). CONCLUSION: There was no significant difference in the onset of action, duration of sedation and vital parameters between the two groups. Bupivacaine with Clonidine produced longer duration of analgesia compared to Ropivacaine with Clonidine. Hence 0.25% Bupivacaine 0.5ml/kg with Clonidine 1μg/kg is a better choice than 0.25% Ropivacaine 0.5ml/kg with Clonidine 1μg/kg for short surgical procedures like circumcision.