Enhancement of bupivacaine caudal analgesia by using dexamethasone or clonidine in children undergoing subumbilical surgery

Abstract

Background and aims Caudal analgesia produces profound intraoperative, as well as postoperative analgesia, with minimal psychological alteration in children. Because of its short duration, various additives have been used to prolong the duration of analgesia. The present study aimed to evaluate the effect of adding dexamethasone and clonidine to bupivacaine in caudal analgesia for children undergoing subumbilical surgeries. Patients and methods We conducted a prospective, randomized, single-blinded study on 100 patients of either sex belonging to the American Society of Anesthesiologists' physical status I, II in the age group 1-12 years, and undergoing subumbilical surgery under general anesthesia, were enrolled. Written informed consent was obtained from their parents. Patients were randomly divided into two groups (group D and C). Group D received 1 ml/kg of 0.25% bupivacaine with 0.2 mg/kg of dexamethasone in normal saline and group C received 1 ml/kg of 0.25% bupivacaine with 1 mg/kg of clonidine in normal saline, with maximum volume of 12 ml in both the groups. All patients were assessed intraoperatively for hemodynamic changes and requirement of sevoflurane concentration and postoperatively for pain by using FLACC pain score and for sedation by using four-point sedation score. Results The mean duration of analgesia was 18-24 h in group D, whereas in group C it was 12-15 h. Group C had a higher sedation score up to 2 in immediate postoperative period for 1 h compared with below 1 h in group D. Conclusion Postoperative analgesia is longer with dexamethasone compared with clonidine without any side effects.