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Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children.

Author(s): Disma N, Frawley G, Mameli L, Pistorio A, Alberighi OD, Montobbio G, Tuo P

Affiliation(s): Department of Anaesthesia, IRCCS Gaslini Children's Hospital, Genoa, Italy.

Publication date & source: 2011-02, Paediatr Anaesth., 21(2):128-35. Epub 2010 Dec 16.

Publication type: Randomized Controlled Trial

BACKGROUND: Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose-response trial. METHODS: A group of 120 children aged <6 years of age received caudal anesthesia with levobupivacaine and 1, 2, or 3 mug.kg(-1) of clonidine. The MLAC was determined according to a Dixon-Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. RESULTS: The MLAC of caudal levobupivacaine was 0.106%, 0.077%, and 0.035% with 1, 2, and 3 mug.kg(-1) of clonidine, respectively. There were significant dose-dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 mug.kg(-1) of clonidine group. CONCLUSIONS: Clonidine produces a local anesthetic sparing effect with a dose-dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose-dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 mug.kg(-1) of clonidine provides the optimum balance between improved analgesia and minimal side effects. (c) 2010 Blackwell Publishing Ltd.

Page last updated: 2011-12-09

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