Study on the Safety and Efficacy of Clonidine-bupivacaine Combination in Caudal Block for Pediatric Lower Limb and Abdominal Surgeries

Background: Caudal epidural block is a popular regional anesthesia method in children, particularly infraumbilical and lower extremity surgeries. Even though bupivacaine alone is effective in analgesia, it has a rather short duration of action, which restricts its application. α2-adrenergic agonist such as clonidine has been adjuvant in the case of prolonging analgesia and enhancing block. Materials and Methods: It was a prospective, randomized, and controlled study of 60 pediatric patients (1–10 years old) undergoing elective surgeries on limbs and abdomen (American Society of Anesthesiologists I–II). Randomly selected patients (two groups: Group B: 30 patients and Group BC: 30 patients) were treated with bupivacaine (0.25% 1 mL/kg) and clonidine (1 µg/kg) by adding them to either group. Measurements of parameters included length of analgesia after operation, quality of analgesia (observational pain score), hemodynamic variables, and side effects. Results: Group BC (9.8 ± 2.1 h) had significantly more time than Group B (4.5 ± 1.3 h) of postoperative analgesia ( P < 0.001). Group BC always had lower pain scores and rescue analgesic requirements were less. The hemodynamic parameters were stable between the groups and mild sedation was seen in 20% of Group BC patients which was medically tolerable. None of the significant negative events (respiratory depression, bradycardia, and hypotension) were reported. Conclusion: Caudal addition of clonidine to bupivacaine did not have significant adverse effects and increased the duration and quality of analgesia in pediatric lower limb and abdominal operations.