British Journal of Anaesthesia, 2004, Vol. 92, No. 2 223-227
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double-blind study
1 Department of Anaesthesia and Intensive Care, Odense University Hospital, DK-5000 Odense C, Denmark. 2 Department of Anaesthesia, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark
*Corresponding author. E-mail: tomghansen@dadlnet.dk
Background. Clonidine is used increasingly in paediatric anaesthetic practice to prolong the duration of action of caudal block with a local anaesthetic agent. Which route of administration of clonidine is the most beneficial remains unknown. We compared the effects of caudal and i.v. clonidine on postoperative analgesia produced by caudal bupivacaine after hypospadias repair.
Methods. Forty-six children (ASA I or II) aged 24–104 months received standardized premedication with midazolam, a general anaesthetic and a caudal block with bupivacaine 0.25%, 0.5 ml kg–1. The children were randomized in a double-blind fashion to two groups: the i.v. group received clonidine 2 µg kg–1 i.v. and simultaneously the same volume of saline caudally. The caudal group received clonidine 2 µg kg–1 caudally and a similar volume of saline i.v. After surgery, all children received acetaminophen 20 mg kg–1 rectally or orally 6-hourly and were given a patient-controlled or nurse-controlled analgesia (PCA/NCA) pump with i.v. morphine (bolus of 25 µg kg–1 and an 8-min lockout period with no background infusion). Monitoring of scores for pain, sedation, motor block, and postoperative nausea and vomiting was performed by nurses blinded to the study allocations. Time to first activation of the PCA/NCA pump and 0–24 h and 24–48 h morphine consumption were also recorded.
Results. Forty-four children completed the study. Age, weight and duration of anaesthesia and surgery were similar in the two groups. The median (range) time to first activation of the PCA/NCA pump was similar in the two groups: 425 (150–1440) min in the i.v. group and 450 (130–1440) min in the caudal group. The number of children not requiring postoperative morphine was four and seven respectively. Morphine consumption during 0–24 h and 24–48 h was similar between groups.
Conclusions. The analgesic effect of clonidine 2 µg kg–1 as an adjunct to caudal block with bupivacaine 0.25%, 0.5 ml kg–1 is similar whether administered i.v. or caudally.
Br J Anaesth 2004; 92: 223–7
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. R. Vetter, D. Carvallo, J. L. Johnson, M. S. Mazurek, and R. G. Presson Jr A Comparison of Single-Dose Caudal Clonidine, Morphine, or Hydromorphone Combined with Ropivacaine in Pediatric Patients Undergoing Ureteral Reimplantation Anesth. Analg., June 1, 2007; 104(6): 1356 - 1363. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P.-A. Lonnqvist and N. S. Morton Postoperative analgesia in infants and children Br. J. Anaesth., July 1, 2005; 95(1): 59 - 68. [Full Text] [PDF]
|
|
|
|
|
|
S. Mannion, I. Hayes, F. Loughnane, D. B. Murphy, and G. D. Shorten Intravenous but Not Perineural Clonidine Prolongs Postoperative Analgesia After Psoas Compartment Block with 0.5% Levobupivacaine for Hip Fracture Surgery Anesth. Analg., March 1, 2005; 100(3): 873 - 878. [Abstract] [Full Text] [PDF]
|
|