Effect of addition of clonidine to bupivacaine or ropivacaine on caudal efficacy and effectiveness in pediatric patients undergoing infraumblical surgery

Children are not as expressive as adults, but they do feels pain equally. In the perioperative period, pain is the most alarming, upsetting and disturbing symptom for a patient. In pediatric populace, amongst the regional blocks, caudal epidurals with local anesthetics are preferred and universally practiced by anesthesiologists, but comparatively shorter period of analgesia is its major limitation. So, to improve the effectiveness of caudal epidurals, a variety of additives are used besides local anesthetics.

A double-blind, prospective and randomised study was carried on 60 children falling in the age group of 1–6 years belonging to ASA I or II, posted to undergo surgery infraumblically, were allocated randomly to one of two groups of 30 each who then received injection of 0.25% bupivacaine-clonidine(2ug/kg) or 0.25% ropivacaine-clonidine (2μg/kg) @ 1ml/kg caudally. Haemodynamic variables were documented peri-operatively. Pain was assessed using the Modified Hanallah pain score for 24 hours and complications were observed in the postoperative period.

No statistically significant difference was observed when 2ug/kg of clonidine added to 0.25% bupivacaine or 0.25% ropivacaine caudally in pediatric patients, in procedures below the umbilicus with mean duration of analgesia with group BC and RC were mins respectively. Also no significant undesirable side effects like bradycardia, hypotension, urinary incontinence, nausea and vomiting were observed in either of these groups.

The mean extent of analgesia was equally prolonged in both the groups postoperatively. So, clonidine in a dose of 2ug/kg added to 0.25% bupivacaine or 0.25% ropivacaine for caudal analgesia, proves safe and effective method in prolonging the duration of analgesia without producing any significant side effects.