A Comparative Evaluation of Levobupivacaine Hydrochloride and Levobupivacaine Hydrochloride with Clonidine Hydrochloride for Caudal Epidural Anaesthesia in Paediatric Patients Undergoing Elective Infraumbilical Surgeries
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2015, Vol 3, Issue 5
Abstract
The study was carried out on 60 paediatric patients of either sex with age group between 2-8 years belonging to ASA grade I & II scheduled for elective infra-umbilical surgeries. The patients were randomly divided into two groups according to the drug administered. Group L (n=30, control) – 1ml/kg of levobupivacaine hydrochloride 0.25% and 0.5 ml of normal saline injected through the caudal route. Group LC (n=50) - 1 ml/kg of levobupivacaine hydrochloride 0.25% with 1 µg/kg clonidine (made up to 0.5ml in normal saline) injected through the caudal route. After induction of anesthesia and caudal block, patients were observed during the intraoperative and postoperative period for duration of analgesia, duration of motor blockade, post- operative FLACC scores, and hemodynamic and respiratory parameters. Any side effects or complications were recorded, if present.In our study the mean (±SD) duration of analgesia was significantly prolonged in group LC (503.66±89.53) min compared to group L (237.66±49.59) min. The Mean (±SD) FLACC scores which were compared between two groups in the postoperative period showed higher values in Group L as compared to Group LC. The mean (±SD) FLACC score at the time of rescue analgesia was found to be higher in group L (4.16±0.69) compared to group LC (3.16±0.74) which was significantly lower. The mean duration of motor blockade was 106.83±27.80 min for Group L and 99.33±30.27 min for Group LC which were comparable statistically (p>0.05) and the mean(±SD) Modified Bromage scores in the postoperative period were found to be comparable in both groups(p>0.05).The mean pre-induction heart rates were 122.06±11.93 in group L and 122.80 ±16.23 for Group LC. Compared to pre-induction values, significant fall in heart rates were observed in both groups after 15 min. Intergroup comparison of both groups showed a significant decrease in pulse rates (p<0.05) 30 min after induction in LC reaching pre induction levels after 4 hours. The mean pre-induction values of systolic blood pressures were 99.00±6.04 mm Hg in Group L and 101.80±5.72 mm Hg in Group LC. Significant fall in mean values were seen by 15 min of induction. Intergroup comparison showed a fall in mean values in the LC group 30 min post induction (p< 0.05) which soon reached near pre induction values by 60 minutes. The mean diastolic blood pressures in the pre induction period were 63.23±1.88 mm Hg in group L and 62.96±3.13mm Hg in Group LC. Significant fall in Mean±SD values were noted 30 minutes following block in both groups. Intergroup analysis showed a significant decrease in mean values of Group LC 30 minutes post induction which normalised by 1 hour post induction. As per our pre-induction criteria, no significant hypotension or bradycardia was observed in any patient. No significant change was observed in the respiratory rate and SpO2 in both the groups. One subject in group LC had complaints of vomiting. 3 subjects (10%) in L group also had complaints of postoperative shivering while no shivering was noted in the LC group. No other complications were noted in both groups. Keywords: Caudal epidural anaesthesia, Levobupivacaine, Clonidine, Paediatric patients
Authors and Affiliations
Dr. Satyendra S. Yadav, Dr. Preeti Goyal, Dr. B. Choudhary, Dr. Megha Bhagat
Keywords
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