British Journal of Anaesthesia, Vol 80, Issue 3 294-298, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia
I. Constant, O. Gall, L. Gouyet, M. Chauvin and I. Murat
Caudal anaesthesia is indicated for surgical procedures lasting less than
90 min. Fentanyl and clonidine are known to prolong postoperative caudal
analgesia, but there are no data on their effect on duration of surgical
analgesia. We evaluated if the addition of clonidine or fentanyl to local
anaesthetics prolonged the duration of surgical analgesia after single shot
caudal block in children in a randomized, double-blind study. We studied 64
children, aged 6-108 months, undergoing bilateral correction of
vesicoureteral reflux which was expected to last more than 90 min. Patients
were allocated to one of four groups: group O received 1 ml kg-1 of a
mixture of 0.25% bupivacaine with epinephrine and 1% lidocaine in equal
parts; group F received the same mixture of local anaesthetics in addition
to fentanyl 1 microgram kg-1; group C received the same mixture of local
anaesthetics in addition to clonidine 1.5 micrograms kg-1; and group C + F
received the same mixture of local anaesthetics in addition to fentanyl 0.5
microgram kg-1 and clonidine 0.75 microgram kg-1. Single shot caudal block
was sufficient in only 57% of children in group O compared with 93% in
groups C and F and 86% in group C + F (P = 0.035). Global assessment of
anaesthesia, defined as the time from caudal injection to the first
administration of analgesic (either during or after surgery), was
significantly longer in the three groups of children who received additives
compared with local anaesthetics alone (P = 0.035), but there were no
differences between the three additive groups. Vomiting was observed only
in children who received fentanyl. Addition of clonidine or fentanyl to
local anaesthetics prolonged the duration of surgical analgesia of caudal
block, allowing single shot caudal anaesthesia to be recommended for
surgery lasting 90-150 minutes. Clonidine had some advantages over fentanyl
as it did not produce clinically significant side effects.
CLINICAL INVESTIGATIONS
Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children
Department of Anaesthesia, Hopital d'enfants Armand Trousseau, Pairs, France; Department of Anaesthesia and Intensive Care, Hopital Ambroise Pare, Boulogne, France
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