Evaluation of analgesic efficacy of caudal bupivacaine with clonidine versus bupivacaine alone in pediatric laparoscopic surgery

• Published in: Indian Journal of Pain
• Main Authors: Lakshmi Kumar, Mahesh Chandran Nair, Kalesh Divakar, Meenakshi Vijayakumar, Rekha Varghese, Sunil Rajan
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Subjects: bupivacaine; caudal; clonidine; laparoscopy; pediatric
• Online Access: http://www.indianjpain.org/article.asp?issn=0970-5333;year=2021;volume=35;issue=1;spage=62;epage=67;aulast=Kumar

Background: Caudal local anesthetics with and without additives are increasingly being used for pain management in children. The primary objective of the present study was to compare intraoperative fentanyl consumption in pediatric patients undergoing laparoscopic surgeries under general anesthesia with supplemental caudal analgesia with and without addition of clonidine. The secondary outcomes were comparison of intraoperative and postoperative hemodynamic changes, postoperative pain, and postoperative analgesic requirements. Materials and Methods: In this prospective randomized trial, 32 children aged 6 months to 6 years were recruited. Group B received 2 mg/kg bupivacaine in 1.25 ml/kg, while Group BC received 2 mg/kg bupivacaine with 1 µg/kg clonidine in 1.25 ml/kg as caudal medication after induction of general anesthesia. Chi-square test, independent sample t-test, and Mann–Whitney U-test were used as applicable. Results: Intraoperative use of fentanyl and percentage of patients who required additional fentanyl intraoperatively and postoperatively were comparable in both groups. Intraoperative heart rate (HR), systolic blood pressure (SBP), and mean arterial pressure (MAP) were comparable in both groups most of the time. HR was significantly higher in Group B at 1 h intraoperatively with significantly higher SBP at 10 min after caudal. Postoperative HR and SBP were comparable in both groups. Group B had significantly higher MAP in the immediate postoperative period. Postoperative pain as assessed by FLACC (Face, Legs, Activity, Cry, Consolability) scale was comparable between groups with the exception of it being lesser in Group B at 8 h postoperatively. Conclusion: Clonidine 1 µg/kg added to caudal bupivacaine did not improve analgesia in comparison to bupivacaine alone in children undergoing laparoscopic surgery.