A comparative study to assess the efficacy of clonidine and fentanyl when used as an adjuvant for paediatric caudal analgesia
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 4
Abstract
Background: Caudal analgesia is widely accepted method in paediatric age group to provide intraoperative and postoperative analgesia. Bupivacaine is commonly used local anaesthetic for caudal analgesia. The average duration of analgesia is 60-90 minutes. The different additives such as clonidine, ketamine or opoids are recommended to increase the duration of analgesia. Clonidine is an imidazoline derivative with selective alpha 2 agonist activity. Fentanyl is a short acting opiate agonist. Both drugs prolong and potentiate the duration of caudal analgesia when used with Bupivacaine. Aims and Objectives: We aimed our study to compare the efficacy, duration and quality of analgesia between clonidine and fentanyl when used as adjuvant for paediatric caudal analgesia with bupivacaine 0.5% .We also studied the safety by comparing side effects of two drugs clonidine and fentanyl when used as an adjuvant for paediatric caudal analgesia with bupivacaine 0.5%.. Methodology: This randomised double blind study was performed in 80 patients after ethical committee approval in our medical institute. Age group 3-5 years of both sexes ASA grade I and II undergoing major and minor surgical procedure below umbilical level with caudal anaesthesia with spontaneous ventilation. Patients were randomly divided in two groups 40 patients each. Group C received caudal epidural anaesthesia with bupivacaine (0.5%) 0.5 ml/kg and 1 mcg/kg clonidine. Group D received caudal epidural anaesthesia with bupivacaine (0.5%) 0.5 ml/kg and 1 mcg/kg fentanyl. During intra-op and post op period, other than vital parameters, analgesia and sedation were assessed by Ramsay sedation score. Respiratory depression was defined as spO2 <93% requiring oxygen by face mask. Patients were also monitored for vomiting and respiratory depression. Result: Duration of analgesia in post op period for group C was 5.0+_ 1.2 hours and group F was 4.9+_1.3 hours. Vomiting was observed in 8% in group F and 3% in group C. In both the group, Ramsay sedation score did not fall below 4 and there was no respiratory depression observed. Bradycardia (<100/min) was observed in 6% and 2% in group C and group F respectively. Conclusion: Fentanyl is a better then Clonidine when used as an adjuvant to paediatric caudal analgesia. Clonidine is associated with more hamodynamic changes while Fentanyl has more incidence of post op adverse effects.
Authors and Affiliations
Saif Ahmed, Shilpa Gaikwad, Jyotsana Paranjpe
Keywords
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