Comparative Study of Ropivacaine versus Ropivacaine with Clonidine for Caudal Analgesia in Paediatric Age Group Among Lower Abdominal and Lower Limb Surgery

摘要

"Introduction: Clonidine, an a2 adrenergic agonist, prolongs analgesia without significant respiratory depression. The analgesic action of epidurally-administered clonidine is due to stimulation of descending noradrenergic medullospinal pathways inhibiting the release of nociceptive neurotransmitters in the dorsal horn of spinal cord. The present study was done with the objective of assessing advantages of use of clonidine with Ropivacaine for caudal analgesia in paediatric age group among lower abdominal and lower limb surgery. Methodology: A randomized controlled study consisted in two groups of thirty paediatric patients (1-10 years) each with lower abdominal and lower limb surgery was carried out at Department of Anaesthesia, SMIMER Hospital, Surat during Jan to Dec 2012.Total 60 patients were randomly allocated in two groups by chit method. In Group R patients Inj.Ropivacaine0.25% (0.5 ml/kg) was given and in Group RC patients Inj. Ropivacaine 0.25%(0.5 ml/kg)+ Inj. Clonidine 2mg/kg was given. Patients were assessed for pain Modified objective pain score and sedation assessed with Four Point sedation score. Results: Mean age of patient was 4.77 ± 2.487 years in Group R and 5.37 ± 2.723 yrs in Group RC. Total Male:Female ratio was 9:1. Majority of patients were operated for congenital herniotomy (68.3%) followed by Hypospadiasis repair (16.6%).Mean modified pain score was measured at each hour postoperatively. It was higher at each level in Group R and this difference was statistically significant. The mean duration of analgesia was 7.17 hrs in Group R and 12.93 hrs in Group RC. This difference was also statistically significant (p-Value < 0.001). Conclusion: From the study, it was concluded that the addition of clonidine 2μg/kg to single shot caudal block with Ropivacaine 0.25% prolongs the duration of postopertive analgesia while maintaining hemody-namic stability. Clonidine 2μg/kg is safe & effective adjuvant in caudal block for paediatric lower abdominal and lower limb surgery.