Evaluation of Post-Operative Analgesia Using Clonidine as an Adjuvant with Caudal Bupivacaine in Paediatric Patients Posted for Infraumbilical Surgery

BACKGROUND Caudal epidural block is a highly popular method of administering analgesia to children undergoing infraumbilical surgeries. Addition of clonidine, a centrally acting alpha 2 agonist as an adjuvant to caudal bupivacaine has added advantages of providing prolonged post-operative analgesia and also, thus reducing the number of doses of post-operative rescue analgesics. In this study, we wanted to compare the efficacy and safety of caudally administered clonidine as an adjuvant to bupivacaine. METHODS This was a prospective, comparative interventional study and was conducted in the Department of Anaesthesia at JNMC, Sawangi (Meghe) Wardha in accordance with the guidelines and permission of the institutional ethical review board. The study was carried out with 40 patients in each group randomly allocated using computer generated software, posted for infraumbilical surgeries between the age group 2 years to 7 years, American Society of Anaesthesiologists (ASA) grade I and II. Group B (control group) – Caudal epidural with 0.25 % bupivacaine 1 ml/kg + 1 ml normal saline. Group C (study group)- Caudal epidural with 0.25 % bupivacaine 1 ml/kg with clonidine 1 microgram/kg + 1 ml normal saline. RESULTS In our study, the mean duration of analgesia i.e. mean time for requirement of first rescue analgesia in group C was 9.9 ± 1.4 hours as compared to 4.7 ± 1.4 hours in group B (P < 0.0001). In this study, we used FLACC (face, legs, activity, cry, consolability) pain scale with its 0 - 10 score range for assessing the pain intensity. At FLACC pain score 4 or more, first dose of rescue analgesic was given. This score was reached at 8.8 hours in Group C (mean FLACC score at 3.8 ± 0.7) and 3.6 hours in Group B (mean FLACC score 3.4 ± 0.9) with P value (= 0.014) (significant). Group C required significantly lesser number of rescue analgesics in comparison to Group B. The number of doses of rescue analgesics required in the Group B were definitely more than that in Group C wherein 62.5 % required 3 doses and 25 % required 4 doses of rescue analgesics. On the other hand, in Group C the number of patients requiring more than 2 doses of rescue analgesia was 0 % thus proving the efficacy of clonidine in prolonging post-operative analgesia. CONCLUSIONS We concluded that caudally administered clonidine, in a dose of 1 microgram/kg as an adjuvant to 0.25 % bupivacaine 1 ml/kg, proved to be efficacious in providing prolonged analgesia both intraoperatively and post-operatively. Also, we observed that this addition, reduced the requirement of post-operative rescue analgesia and its associated side effects. KEY WORDS Caudal Epidural, Infraumbilical Paediatric Surgery, Clonidine, Bupivacaine, Postoperative Analgesia