Analgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine

• Published in: Pediatric anesthesia 2001-11, Vol.11 (6), p.695-700
• Main Authors: Sharpe, P., Klein, J.R., Thompson, J.P., Rushman, S.C., Sherwin, J., Wandless, J.G., Fell, D.
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-Agonists - administration & dosage; anaesthetics local: bupivacaine; Analgesia; analgesic techniques: extradural; Anesthesia; Anesthesia, Spinal; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local; Biological and medical sciences; Bupivacaine; Child; Child, Preschool; Circumcision, Male; clonidine; Clonidine - administration & dosage; Humans; Infant; Local anesthesia. Pain (treatment); Male; Medical sciences; Pain Measurement; Pain, Postoperative - epidemiology; Pain, Postoperative - prevention & control; pain: postoperative; sympathetic nervous system: α2 agonists
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1046/j.1460-9592.2001.00748.x

Background: Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain. Methods: We compared the effect of clonidine, 1 and 2 μg·kg–1, added to bupivacaine (1.25 mg·kg–1) with that of bupivacaine alone in 75 male children undergoing elective circumcision. Results: There was a trend towards increasing duration of analgesia with increasing dose of clonidine [group B (bupivacaine) 280.7 (171.6) min, C1 (bupivacaine + clonidine 1 μg·kg–1) 327.8 (188.3) min and C2 (bupivacaine + clonidine 2 μg·kg–1) 382.0 (200.6) min], although this difference was not statistically significant. Mean time to arousal from anaesthesia was significantly prolonged with clonidine 2 μg kg–1 (group C2 21.3 (13–36) min, group C1 14.0 (6–25) min and group B 14.4 (2–32) min. Supplementary analgesic requirements and incidence of adverse effects were low, with no differences between the groups. Conclusions: For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 μg·kg–1 to low volume (0.5 ml·kg–1) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision.