Key result
Caudal clonidine added to bupivacaine significantly prolonged the mean duration of post-operative analgesia to 601.5 minutes compared to fentanyl (342.4 minutes) and bupivacaine alone (241.3 minutes).
Why the study?
Does the addition of fentanyl or clonidine to bupivacaine improve the duration of post-operative analgesia in children undergoing genitourinary and inguinal surgeries?
RCT (n=120)
Randomized
No
Does the addition of fentanyl or clonidine to bupivacaine improve the duration of post-operative analgesia in children undergoing genitourinary and inguinal surgeries?
Absolute Event Rate: 601.5% vs 241.25%
p-value: p=0.00001
Caudal clonidine is a more effective adjuvant than fentanyl for prolonging bupivacaine analgesia in pediatric genitourinary and inguinal surgeries, though it is associated with increased sedation.
Clonidine may be preferred over fentanyl as caudal adjuvant in pediatric genitourinary surgery; extends RCT evidence but requires sedation monitoring.
Post-operative analgesia in children is a challenging task before the anesthesiologist.Caudal analgesia is an accepted and popular method of providing intraoperative and postoperative analgesia for genitourinary and inguinal surgeries in children.Because of short duration of action of Bupivacaine, various adjuncts have been tried by many anesthesiologists.Fentanyl and Clonidine are used along with local anesthetics to prolong duration of analgesia.Hence we are comparing 1 mcg/kg of Fentanyl and 1 mcg/kg of Clonidine as adjuvants to 0.25% bupivacaine at a volume of 0.75 ml/kg in children undergoing genitourinary and inguinal surgeries.AIMS AND OBJECTIVES: To compare the efficacy of Fentanyl and Clonidine as adjuncts to Bupivacaine for postoperative analgesia in pediatric patients and to evaluate the sequel and side effects of both.MATERIALS AND METHODS: Study design -Comparative randomized controlled study.Sample size: 120 children aged between 2-7 years posted for genitourinary and inguinal surgeries.Group I (B) received 0.75 ml/kg of 0.25% Bupivacaine alone caudally.Group II (BF) received 0.75 ml/kg of 0.25% Bupivacaine and 1 µg/kg Fentanyl caudally.Group III (BC) received 0.75 ml/kg of 0.25% Bupivacaine and 1 µg/kg Clonidine caudally.Postoperatively the duration of analgesia, motor blockade and sedation was assessed by Modified Objective Pain Scale, Ramsay Sedation Score and modified Bromage scale respectively.Side effects and complications, if present were recorded.Tests used for statistical analysis were Fishers exact test and student t test.RESULTS: The mean duration of analgesia in group BC (601.5 + 60.17 minutes) was much higher than group BF and B but with side effect of sedation.We observed that there was a statistically increased duration of analgesia in Clonidine group as compared to Fentanyl and plain Bupivacaine group with no difference in duration of motor blockade.There was increased sedation in group BC.Group BF had nausea and vomiting, shivering and pruritus as side effects.Hence we conclude that Clonidine is a better adjunct than Fentanyl in prolonging duration of analgesia of Bupivacaine in pediatric caudal block.
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Gupta et al. (2014) conducted an RCT in Post-operative pain (n=120). Clonidine vs. Fentanyl (1 µg/kg) or Bupivacaine alone was evaluated on Duration of analgesia (minutes) (p=0.00001). Caudal clonidine added to bupivacaine significantly prolonged the mean duration of post-operative analgesia to 601.5 minutes compared to fentanyl (342.4 minutes) and bupivacaine alone (241.3 minutes).
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