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Xu W, Wei H, Zhang T. Methods of prolonging the effect of caudal block in children. Front Pediatr 2024; 12:1406263. [PMID: 38887564 PMCID: PMC11180814 DOI: 10.3389/fped.2024.1406263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
Caudal epidural blockade is one of the most frequently administered regional anesthesia techniques in children. It is a supplement during general anesthesia and for providing postoperative analgesia in pediatrics for sub-umbilical surgeries, especially for genitourinary surgeries. However, the duration of the analgesic effect is occasionally unsatisfactory. In this review, we discuss the main advantages and disadvantages of different techniques to prolong postoperative analgesia for single-injection caudal blockade in children. A literature search of the keywords "caudal", "analgesia", "pediatric", and "children" was performed using PubMed and Web of Science databases. We highlight that analgesic quality correlates substantially with the local anesthetic's type, dose, the timing relationship between caudal block and surgery, caudal catheterization, and administration of epidural opioids or other adjuvant drugs.
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Affiliation(s)
| | | | - Tao Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Shah UJ, Karuppiah N, Karapetyan H, Martin J, Sehmbi H. Analgesic Efficacy of Adjuvant Medications in the Pediatric Caudal Block for Infraumbilical Surgery: A Network Meta-Analysis of Randomized Controlled Trials. Cureus 2022; 14:e28582. [PMID: 36185831 PMCID: PMC9521396 DOI: 10.7759/cureus.28582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Various adjuvants are added to local anesthetics in caudal block to improve analgesia. The comparative analgesic effectiveness and relative rankings of these adjuvants are unknown. This network meta-analysis (NMA) sought to evaluate the comparative analgesic efficacy and relative ranking of caudal adjuvants added to local anesthetics (versus local anesthetics alone) in pediatric infra-umbilical surgery. We searched the United States National Library of Medicine database (MEDLINE), PubMed, and Excerpta Medica database (Embase) for randomized controlled trials (RCTs) comparing caudal adjuvants (clonidine, dexmedetomidine, ketamine, magnesium, morphine, fentanyl, tramadol, dexamethasone, and neostigmine) among themselves, or to no adjuvant (control). We performed a frequentist NMA and employed Cochrane's 'Risk of Bias' tool to evaluate study quality. We chose the duration of analgesia (defined as 'the time from caudal injection to the time of rescue analgesia') as our primary outcome. We also assessed the number of analgesic dose administrations and total dose of acetaminophen within 24 h. The duration of analgesia [87 randomized control trials (RCTs), 5285 patients] was most prolonged by neostigmine [mean difference: 513 min, (95% confidence interval, CI: 402, 625)]. Dexmedetomidine reduced the frequency of analgesic dose administrations within 24 h [29 RCTs, 1765 patients; -1.2 dose (95% CI: -1.6, -0.9)] and the total dose of acetaminophen within 24 h [18 RCTs, 1156 patients; -350 mg (95% CI: -467, -232)] the most. Among caudal adjuvants, neostigmine (moderate certainty), tramadol (low certainty), and dexmedetomidine (low certainty) prolonged the duration of analgesia the most. Dexmedetomidine also reduced the analgesic frequency and consumption more than other caudal adjuvants (moderate certainty).
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Affiliation(s)
- Ushma J Shah
- Anesthesia & Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
| | - Niveditha Karuppiah
- Anesthesia & Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
| | | | - Janet Martin
- Anesthesia & Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
| | - Herman Sehmbi
- Anesthesia & Perioperative Medicine, London Health Sciences Centre, Western University, London, CAN
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Xiong C, Han C, Lv H, Xu D, Peng W, Zhao D, Lan Z. Comparison of adjuvant pharmaceuticals for caudal block in pediatric lower abdominal and urological surgeries: A network meta-analysis. J Clin Anesth 2022; 81:110907. [PMID: 35728381 DOI: 10.1016/j.jclinane.2022.110907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Caudal block helps relieve pain after sub-umbilical surgery in pediatric patients; however, the duration for which it exerts its analgesic effect is limited. The addition of certain adjuvant agents to local anesthetics (LAs) that are used to administer caudal block can prolong postoperative analgesia. Therefore, we aimed to compare the efficiencies and side effects of caudal adjuvants in the settings of pediatric lower abdominal and urological surgeries. DESIGN A network meta-analysis (NMA). PATIENTS One hundred and twelve randomized controlled trials (RCTs) involving 6800 pediatric patients were included in the final analysis. INTERVENTIONS Different adjuvant agents, namely clonidine, dexamethasone, dexmedetomidine, fentanyl, ketamine, magnesium, midazolam, morphine, neostigmine, and tramadol. MEASUREMENTS The primary outcome was the duration of analgesia. The secondary outcomes included the requirement for additional analgesia, analgesic consumption, and postoperative complications. The effects and rankings were evaluated using NMA and the surface under the cumulative ranking curve scores, respectively. RESULTS Neostigmine, dexmedetomidine, and dexamethasone were found to be the three most effective adjuvants that prolong the duration of analgesia for caudal block, and these adjuvants extended this duration by 8.9 h (95% confidence interval [CI], 7.1-10.7), 7.3 h (95% CI, 6.0-8.6), and 5.9 h (95% CI, 4.0-7.7), respectively. Caudal neostigmine was associated with an increase in the incidence of postoperative nausea and vomiting, whereas dexmedetomidine and dexamethasone showed no postoperative complications. CONCLUSIONS This NMA provided evidence and suggested that dexmedetomidine and dexamethasone may be the most beneficial adjuvant pharmaceutics adding to LAs for caudal block in children. However, given the off-label status of caudal dexmedetomidine and dexamethasone, further high-quality RCTs are still warranted, especially to determine whether delayed neurological complications will occur.
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Affiliation(s)
- Chang Xiong
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Chengpeng Han
- Department of Children's Rehabilitation, Jinhua Maternal and Child Health Care Hospital, Jinhua, Zhejiang Province, People's Republic of China
| | - Huayan Lv
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Duojia Xu
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Wenyong Peng
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Dong Zhao
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
| | - Zhijian Lan
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
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Review of clinical evidence of caudal block for postoperative analgesia in children with ketamine added local anesthetics. Ann Med Surg (Lond) 2022; 75:103480. [PMID: 35386802 PMCID: PMC8978094 DOI: 10.1016/j.amsu.2022.103480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/05/2022] Open
Abstract
Background Adding ketamine to local anesthetics used for caudal block in children is an emerging clinical practice. This review aims to resolve controversies related to this adjuvant for a caudal block in children who underwent sub-umbilical surgeries. Methods Between January 2010 and November 2021, PubMed, Cochrane Review, and Google Scholar were searched for a caudal block with ketamine added local anesthetics for children. After screening for eligibility and removing duplicates, 38,187 articles were found, 13 reviewed. Discussion Despite adding ketamine to local anesthetics used for a caudal block, it is a recent technique practiced worldwide. Ketamine showed equi-efficacious as other adjuvants used for the caudal block to control postoperative pain in children. Conclusion Ketamine with a 0.5 mg/kg dose is safe and effective to manage postoperative children's pain when used as an adjuvant to local anesthetics used for caudal block. Caudal additives prolong the length of analgesia than local anesthetics alone Ketamine is an alternative to be added for local anesthetics in a caudal block for children Ketamine in caudal block prolongs analgesia and reduces opioid intake.
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Prajapati DJ, Patel M, Patel P, Vijayakumar M, Ganpule A, Mistry D. Effect of caudal bupivacaine alone and with adjuvant fentanyl and nalbuphine to minimize the catheter-related bladder discomfort after tubeless percutaneous nephrolithotomy: A prospective randomized study. J Anaesthesiol Clin Pharmacol 2021; 36:524-530. [PMID: 33840935 PMCID: PMC8022066 DOI: 10.4103/joacp.joacp_285_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/09/2019] [Accepted: 12/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background and Aims: Catheter-related bladder discomfort (CRBD) is a major cause of postoperative morbidity following urological procedures. The aim of this study was to compare the effect of caudal bupivacaine alone and with adjuvant fentanyl and nalbuphine to minimize the severity of CRBD after tubeless percutaneous nephrolithotomy (PCNL). Material and Methods: A randomized prospective study was conducted on one hundred thirty-two (American society of Anaesthesiologist physical status I to II) patients who presented for tubeless PCNL under general anesthesia. Patients were randomly divided into four groups control (C), bupivacaine (B), bupivacaine-fentanyl (BF), and bupivacaine-nalbuphine (BN) by using computer-generated codes. All patients received local infiltration at the procedure site while Groups B, BF, and BN received caudal epidural block (CEB) under ultrasound guidance after conclusion of the procedure. Groups B, BF, and BN received bupivacaine alone, bupivacaine-fentanyl, and bupivacaine-nalbuphine, respectively, for CEB. Patients were monitored 24 h for CRBD scale, visual analogue score (VAS), and duration of analgesia at 30 min, 1, 2, 4, 6, 12, 18, and 24 h intervals. The analgesics were supplemented if the CRBD score was >2 and VAS was ≥4. Student t-test, analysis of variance, and Chi-square test were applied for quantitative, within group occurrence, and qualitative analysis respectively. Results: The CRBD scores were considerably lower in the Groups BF and BN as compared to Groups C and B during the first four hours. The duration of analgesia was significantly prolonged in Group BN (475 ± 47 min) versus BF (320 ± 68 min) versus B (104 ± 40 min) versus C (26 ± 14 min). Conclusions: The severity of CRBD can be reduced with CEB. The effect of CEB can be prolonged with the addition of opioid.
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Affiliation(s)
- Dinesh J Prajapati
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Manoj Patel
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Pankaj Patel
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mohankumar Vijayakumar
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Deepak Mistry
- Department of Anaesthesiology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Ram GK, Dubey PK, Akhileshwar P, Ranjan A. Dexmedetomidine and Ketamine as an Adjuvant to Levobupivacaine for Pediatric Caudal Analgesia: A Randomized, Controlled Study. Anesth Essays Res 2020; 14:253-258. [PMID: 33487825 PMCID: PMC7819406 DOI: 10.4103/aer.aer_42_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Ketamine and dexmedetomidine as an adjuvant to caudal block are used in the pediatric population. Aims: We aimed to compare the analgesic and safety profile of dexmedetomidine with ketamine for single-shot caudal block. Settings and Design: This was a randomized controlled study conducted in a tertiary care university hospital. Materials and Methods: Ninety patients admitted for routine infraumbilical surgical procedures under general anesthesia were enrolled in this double-blind randomized study. Following caudal block under general anesthesia, patients were allocated to one of three groups; Group LS received 0.75 mL.kg − 1 levobupivacaine 0.25% diluted in saline 0.9%, Group LK received 0.75 mL.kg − 1 levobupivacaine 0.25% with ketamine 0.5 mg.kg − 1, and Group LD received 0.75 mL.kg − 1 levobupivacaine 0.25% with dexmedetomidine 1 μg.kg − 1. Postoperative pain was assessed by the Face, Legs, Activity, Cry, and Consolability (FLACC) score, and the duration of analgesia (time from caudal block to time at which FLACC score 4 or more) was recorded. Hemodynamic parameters and oxygen saturation were also monitored. Statistical Analysis Used: Categorical data were analyzed by Chi-squire test and numerical continuous data were analyzed by Student's t-test for comparison between two groups. Mann–Whitney test was used to compare score. One-way analysis of variance was used to compare the means between three groups. Results: The addition of dexmedetomidine and ketamine to levobupivacaine resulted in significant prolongation of postoperative analgesia duration (467 min and 385 min, respectively) compared with 0.25% levobupivacaine alone (276 min). No significant side effects requiring intervention were observed in any group. Conclusions: Dexmedetomidine as an adjuvant to levobupivacaine provides a longer duration of analgesia as compared to ketamine without any significant side effect.
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Affiliation(s)
- Ganesh K Ram
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Prakash K Dubey
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - P Akhileshwar
- Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Alok Ranjan
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Meghana MVS, Deshmukh J, Devarathanamma MV, Asif K, Jyothi L, Sindhura H. Comparison of effect of curcumin gel and noneugenol periodontal dressing in tissue response, early wound healing, and pain assessment following periodontal flap surgery in chronic periodontitis patients. J Indian Soc Periodontol 2020; 24:54-59. [PMID: 31983846 PMCID: PMC6961441 DOI: 10.4103/jisp.jisp_105_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/29/2019] [Accepted: 08/16/2019] [Indexed: 01/08/2023] Open
Abstract
Background The study was designed taking into consideration the drawbacks of periodontal dressing and healing properties of curcumin. The aim was to assess and compare the effect of Curcumin gel (Curenext) and noneugenol periodontal dressing (Coe pak) on tissue response, wound healing in the early stages, and pain post periodontal flap surgery in patients diagnosed with chronic periodontitis. Materials and Methods Twenty patients requiring periodontal flap surgery were allotted to two groups at random, one receiving periodontal dressing and the other receiving curcumin for this cross over split-mouth study. Flap surgeries were performed on 2 quadrants with 3 weeks' interval. After suture removal, postoperative sites were assessed for tissue response (tissue color [TC] and tissue edema [TE]) and early wound healing as primary outcomes of the study. The secondary outcome was pain assessment and the number of analgesics taken by the individuals. Results The two groups showed no significant differences with respect to tissue response, early wound healing, and pain perception. Curcumin group consumed lesser number of analgesics as compared to the one with periodontal dressing. Conclusion It was confirmed that periodontal dressing and curcumin are effective in reducing the TE, normalizing the TC, enhancing the wound healing and reducing the pain perception. Curcumin can thus be used as an alternative to periodontal dressing.
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Affiliation(s)
- M Venkata Sai Meghana
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Jeevanand Deshmukh
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - M V Devarathanamma
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - K Asif
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - L Jyothi
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - H Sindhura
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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Das R, Deshmukh J, Asif K, Sindhura H, Devarathanamma MV, Jyothi L. Comparative evaluation of analgesic and anti-inflammatory efficacy of ibuprofen and traumeel after periodontal flap surgery: A randomized triple-blind clinical trial. J Indian Soc Periodontol 2019; 23:549-553. [PMID: 31849401 PMCID: PMC6906911 DOI: 10.4103/jisp.jisp_85_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Pain management after performing flap surgery is of paramount importance. Taking into consideration the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs), and the advantages of homeopathic medication, the analgesic and anti-inflammatory properties of ibuprofen (NSAID) and traumeel (homeopathic AID) following flap surgery were evaluated. Materials and Methods: A randomized, triple-blinded, split-mouth clinical trial, with a sample size of 20 (age range of 20–60 years) was planned. Subjects included patients diagnosed with moderate chronic generalized periodontitis. Two quadrants for each subject were operated on, with an interval of 3 weeks. Random assignment of the operated quadrants to the following medication protocols was carried out by a third person: Ibuprofen, 600 mg and traumeel, 600 mg (up to three tablets) every 8 h for first 24 h and SOS (Si Opus Sit/if needed) thereafter for a period of 1 week as pain medication, respectively. After 1 week, sutures were removed. Primary outcomes were mean postoperative pain (modified visual analog scale) and number of tablets consumed in 1 week. The secondary outcome was postoperative tissue response. Any adverse effects were recorded. Results: Number of tablets consumed and pain perception was lower in traumeel compared to ibuprofen Group (P < 0.001). A better tissue response was shown by the group treated with traumeel as compared to the ibuprofen receiving group (P < 0.05). Three patients reported adverse drug reactions after consumption of ibuprofen. Conclusion: The present study suggested that while managing pain following flap surgery, traumeel was superior as compared to ibuprofen, with minimal or no side effects.
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Affiliation(s)
- Revu Das
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Jeevanand Deshmukh
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Kardkal Asif
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Harsha Sindhura
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | | | - Lakshminarayana Jyothi
- Department of Periodontology, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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Mohamed S, Sayed D, El Sherif F, Abd El-Rahman A. Effect of local wound infiltration with ketamine versus dexmedetomidine on postoperative pain and stress after abdominal hysterectomy, a randomized trial. Eur J Pain 2018; 22:951-960. [DOI: 10.1002/ejp.1181] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/06/2022]
Affiliation(s)
- S.A. Mohamed
- Anaesthesia, ICU, and Pain Management; South Egypt Cancer Institute; Assiut University; Egypt
| | - D.M. Sayed
- Clinical Pathology Department; South Egypt Cancer Institute; Assiut University; Egypt
| | - F.A. El Sherif
- Anaesthesia, ICU, and Pain Management; South Egypt Cancer Institute; Assiut University; Egypt
| | - A.M. Abd El-Rahman
- Anaesthesia, ICU, and Pain Management; South Egypt Cancer Institute; Assiut University; Egypt
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Ahuja S, Aggarwal M, Joshi N, Chaudhry S, Madhu SV. Efficacy of Caudal Clonidine and Fentanyl on Analgesia, Neuroendocrine Stress Response and Emergence Agitation in Children Undergoing Lower Abdominal Surgeries Under General Anaesthesia with Sevoflurane. J Clin Diagn Res 2015; 9:UC01-5. [PMID: 26500980 PMCID: PMC4606309 DOI: 10.7860/jcdr/2015/12993.6423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/09/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Clonidine has proved to be effective drug for postoperative analgesia but it's efficacy to alter neuroendocrine stress response and emergence agitation is unknown. This study was conducted to assess and compare the efficacy of caudal fentanyl vs. clonidine for analgesia, blunting of neuroendocrine stress responses (NESR) and emergence agitation (EA) following sevoflurane anaesthesia. MATERIALS AND METHODS This prospective, randomized, double blind study enrolled 60 children undergoing infraumbilical surgery. Three groups of 20 each were assigned to receive caudal block with either bupivacaine 0.25% 1 ml/kg with normal saline (group I) or bupivacaine 0.25% 1 ml/kg and 1 microgram*kg-1fentanyl (group II), or bupivacaine 0.25% 1 ml/kg and 3 μg/kg clonidine [group III]. Postoperative analgesia, sedation, NESR, emergence agitation and side effects were observed. RESULTS VAS score at two hours was significantly less in group III (0.60± 0.60) than in group I (1.80± 0.41) and group II (1.25± 0.44), the time to rescue analgesia was also significantly greater in group III (8.03+0.41hours) than groups I and II (4.15± 0.54 hours) and (6.18± 0.5hours) respectively. The EA scores were significantly better in Group III but patients were significantly more sedated postoperatively. Intraoperatively, NESR was blunted in all the groups and the markers of NESR were lowest in group III. CONCLUSION Caudal clonidine in a dose of 3 μg/kg prolongs analgesia and decreases emergence agitation as compared to bupivacaine alone or with fentanyl 1μg/kg. Modulation of the neuroendocrine stress response was observed in all the investigated groups though the indicators were lowest in clonidine group.
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Affiliation(s)
- Sharmila Ahuja
- Professor, Department of Anaesthesia, UCMS and GTBH, New Delhi, India
| | - Megha Aggarwal
- Senior Resident, Department of Anaesthesia, UCMS and GTBH, New Delhi, India
| | - Nandita Joshi
- Specialist, Department of Anaesthesia, UCMS and GTBH, New Delhi, India
| | - Sujata Chaudhry
- Director Professor, Department of Anaesthesia, UCMS and GTBH, New Delhi, India
| | - SV Madhu
- HOD, Department of Medicine, UCMS and GTBH, New Delhi, India
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