A Study of Comparison of Post-Operative Analgesia after Single-Shot Caudal Epidural Block Using Bupivacaine with or without Clonidine in Children

Abstract

Introduction: Lower abdominal surgeries are one of the most frequently performed surgeries in the pediatric age group. A large number of these operations are done as day-care procedures.

Caudal block is one of the most common regional anesthetic techniques in children being used to supplement general anesthesia for a wide variety of sacral-segment surgery. The local anesthetics currently in use are safe and their pharmacological effects have been well evaluated. There is no fear of neurological sequelae
as in the past.

Several studies have demonstrated that Clonidine added to the local anesthetic in caudal block both enhances and prolongs the analgesia produced by the block without the unpleasant or hazardous sideeffects associated with the use of other adjuvant drugs like opioids, epinephrine and some newer adjuvants like neostigmine and dexmedetomidine. Our study aimed to evaluate the efficacy of single-dose caudal epidural Clonidine in prolonging the post-operative analgesia when mixed with Bupivacaine in children.

Materials and Methods

Sixty children of ASA I and ASA II physical status, between 1 and 12 years of age, who underwent elective lower abdominal surgeries, were randomly divided into two groups B (N=30) and C (N=30). All the children were administered general anesthesia. After induction, a single-shot caudal block was administered using 0.25% Bupivacaine (group B) and 1.5 mg/kg of Clonidine hydrochloride (group C). Vital monitoring was done intraoperatively as per institutional protocol. Post-operative monitoring was done in the post-anesthesia care unit (PACU) for 2–3 hours and in the ward for next 24 hours. Data with respect to duration of surgery, duration of pain-free period, time to void and any other complications was compiled. The final results of the study were tabulated and analyzed for significance using standard statistical techniques (unpaired t-test).

Results

This study was undertaken to evaluate the efficacy of Clonidine in prolonging post-operative analgesia of Bupivacaine when given caudally in 60 children undergoing lower abdominal surgeries. The duration of pain-free period with caudal Bupivacaine with Clonidine (group C) is significantly longer than caudal
Bupivacaine (group B). The duration of pain relief was 20.4 hours in group C as compared to 14.2 hours in group B. This is statistically significant (p<0.05).

Conclusion

We conclude that adding Clonidine 1.5 mg/kg to Bupivacaine 0.25% for caudal anesthesia in children undergoing lower abdominal surgeries enhances and prolongs postoperative analgesia compared to caudal Bupivacaine 0.25% alone. Clonidine may be the drug of choice to prolong the duration of caudal anesthesia
provided by a single injection in children.