Postoperative Analgesia in Neonates and Infants Using Epidural Chloroprocaine and Clonidine

• Main Authors: Gibbs A, Kim SS, Heydinger G, Veneziano G, Tobias J
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-10-01
• Series: Journal of Pain Research
• Subjects: chloroprocaine; epidural analgesia; clonidine; neonatal anesthesia
• Online Access: https://www.dovepress.com/postoperative-analgesia-in-neonates-and-infants-using-epidural-chlorop-peer-reviewed-article-JPR
• ISSN: 1178-7090

Anna Gibbs,1 Stephani S Kim,2 Grant Heydinger,2,3 Giorgio Veneziano,2,3 Joseph Tobias2,3 1The Ohio State University College of Medicine, Columbus, OH, USA; 2Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 3Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USACorrespondence: Giorgio VenezianoNationwide Children’s Hospital, Columbus, OH 43205, USATel [phone]Fax [phone]Email [e-mail]: In neonates and infants, epidural analgesia has gained popularity as a means of providing postoperative analgesia, limiting opioid-related adverse effects and improving the postoperative course. In addition to a local anesthetic agent, adjunctive agents may be added to further augment analgesia. Clonidine is an α2-adrenergic agonist that is frequently added to single-shot caudal analgesia, but there are limited data regarding its use in a continuous epidural infusion, especially in patients ≤ 12 months of age.Methods: We retrospectively reviewed the hospital records of neonates and infants who received postoperative epidural infusions with 2-chloroprocaine, and clonidine was identified over a 4-year period.Results: The study cohort included 52 neonates and infants ranging in age from 0 to 12 months and in weight from 2.1 to 10.1 kilograms. The catheters were dosed with either 1.5% 2-chloroprocaine (n=47) or 3% 2-chloroprocaine (n=5) with clonidine (median concentration 0.2 μg/mL) infused at a median rate of 0.72 mL/kg/hour. Pain scores were uniformly ≤ 3 at all evaluation points during the first 72 postoperative hours with a limited need for supplemental systemic opioids. No serious adverse effects were noted.Conclusion: With the recognized limitations of a retrospective study, these preliminary data demonstrate the safety of adding clonidine to an epidural infusion of 2-chloroprocaine in neonates and infants less than 12 months of age. Future studies are needed to determine its analgesic efficacy compared to 2-chloroprocaine alone and the optimal clonidine concentration for postoperative epidural infusions.Keywords: chloroprocaine, epidural analgesia, clonidine, neonatal anesthesia