Effect of caudal clonidine on emergence agitation and postoperative analgesia after sevoflurane anaesthesia in children: Randomised comparison of two doses

Effect of caudally administered clonidine on sevoflurane induced emergence agitation—A randomized trial

Background and Aims:

Emergence agitation (EA) is an unpleasant problem encountered in children following anesthesia with Sevoflurane. We studied the effectiveness of caudal epidural block (CEB) with ropivacaine 0.2% and clonidine two microgram per kilogram (mcg/kg) on the incidence of EA, with respiratory depression and hemodynamic variables as secondary end points.

Material and Methods:

Ninety children aged one to eight years undergoing infra umbilical surgeries were randomly allocated into two groups. Group RS: Ropivacaine 0.2% one ml/kg + . Saline one ml and Group RC: Ropivacaine 0.2% one ml/kg + Clonidine two mcg/kg made to one ml. They were then administered general anesthesia with endotracheal intubation followed by CEB using test drugs. Post surgery, EA was evaluated by Modified Richmond Agitation Scale at 15-minute intervals for one hour. The results were then analyzed using mean and standard deviation (SD), Chi square test, and Independent t test.

Results:

EA was significantly lower in group RC when compared to group RS (P < 0.0001). Group RC had 12 (28.5%) children with EA at 15 minutes compared to 35 (83.3%) children in Group RS. At 30 minutes, it was seen in five (11.3%) and 27 (64.2%) children in group RC and RS, respectively. No significant respiratory depression was noted in both groups. A significant decrease in heart rate was seen in Group RC (P < 0.001) but was not significant clinically. No adverse events were recorded in both the groups.

Conclusion:

Addition of clonidine (2mcg/kg) to ropivacaine 0.2% offers an advantage over 0.2% ropivacaine alone in decreasing the incidence of sevoflurane induced EA in children undergoing lower abdominal surgery without any adverse effects.

A comparison of dexamethasone and clonidine as an adjuvant for caudal blocks in pediatric urogenital surgeries

Background:

Caudal block is a reliable regional analgesic technique for pediatric urogenital surgeries. Various adjuvants have been tried to enhance the duration of action of bupivicaine. Though clonidine is extensively used as an adjuvant in caudal anaesthesia, it can have troublesome adverse effects like bradycardia, hypotension and sedation. Lately dexamethasone has become popular as an adjuvant in paediatric caudals due to its safety profile.

Aim:

The aim of this study was to compare dexamethasone and clonidine coadministered with bupivicaine caudally in paediatric patients undergoing urogenital surgeries in terms of analgesia and adverse effects.

Settings and Design:

Prospective, double blinded randomised study.

Subjects and Method:

Sixty American Society of Anesthesiologists physical status I and II children, aged 1-6 years undergoing urogenital surgeries were allocated in 2 groups: Group I: 0.5 mL.kg⁻¹ of 0.25% bupivicaine with dexamethasone 0.1 mg.kg⁻¹ in 1 ml normal saline (NS) Group II: 0.5 mL.kg⁻¹ of 0.25% bupivicaine with clonidine 1 μg.kg⁻¹ diluted in 1 ml normal saline. The parameters studied included duration of analgesia, intraoperative and postoperative hemodynamics, sedation scores and incidence of adverse effects like wound dehiscence, bleeding, vomiting and respiratory depression.

Statistical Analysis Used:

Statistical analysis was carried out using Stata Version 10. After checking for the normality assumption, t-test for comparing means of two independent samples was used for comparing baseline continuous variables. P values <0.05 were considered significant.

Results:

Patients in Group II had longer duration of analgesia postoperatively. Patients in this group also had lower heart rate and more sedation scores.

Conclusion:

Our study shows that caudal dexamethasone is a good alternative to clonidine with more stable hemodynamics and lesser sedation scores in the immediate postoperative period. Both the drugs offer good analgesia postoperatively with the duration of analgesia more in clonidine.