Spinal Anaesthesia in children: Comparative study of isobaric Levobupivacaine 0.5% with or without Clonidine

Spinal anaesthesia reduces the incidence of morbidity that follows general anaesthesia in children with good efficacy and safety record. Racemic bupivacaine is the widely used local anaesthetic for paediatric spinal anaesthesia. Local anaesthetic levobupivacaine has an equivalent potency to that of racemic bupivacaine but with a greater safety margin. Limited duration of surgical anaesthesia is however, one of the major deterrents for widespread use of spinal anesthesia in children. Clonidine lengthens spinal anaesthesia in adults and in children. We conducted a prospective, randomized clinical trial to study the effect of the addition of clonidine to 0.5% isobaric levobupivacaine induced spinal anaesthesia in children undergoing infra-umbilical procedures.

Sixty patients between 5 to 10 years, posted for infra-umbilical surgeries were given spinal anaesthesia with either 0.5% plain isobaric levobupivacaine (5–15 kg – 0.4 mg/kg, 15–40 kg – 0.3 mg/kg) or levobupivacaine (5–15 kg – 0.4 mg/kg, 15–40 kg – 0.3 mg/kg) with clonidine (1μg/kg). Blockade characteristics and duration of analgesia were recorded along with mean arterial pressure, heart rate, respiratory rate and SpO₂.

Satisfactory surgical anaesthesia was achieved in all 60 patients with comparable mean arterial pressure, heart rate, respiratory rate and SpO₂. Block extension was 2 segments higher in patients given intrathecal clonidine. Duration of spinal anaesthesia (2 segment regression) increased from (90.3 ± 7.2 min) in the control group to (143.5 ± 8.7 min) in the group receiving clonidine 1μg/kg (p<0.001) and postoperative analgesia from 228 ± 14 min to 360 ± 31min (p<0.001). Sedation was the most common side effect observed in children receiving intrathecal clonidine.

We conclude that clonidine 1μg/kg provides a significant improvement in spinal anesthesia and analgesic duration without undesirable side-effects.