Randomized controlled trial comparing morphine or clonidine with bupivacaine for caudal analgesia in children undergoing upper abdominal surgery.

Author(s): Singh R, Kumar N, Singh P

Affiliation(s): Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Publication date & source: 2011-01, Br J Anaesth., 106(1):96-100. Epub 2010 Oct 14.

Publication type: Comparative Study; Randomized Controlled Trial

BACKGROUND: Various additives have been used to increase the duration of analgesia provided by bupivacaine administered by single-shot caudal injection in children. METHODS: A prospective, randomized, double-blind controlled study in 50 ASA I-II children (34 boys and 16 girls) aged 1-6 yr undergoing upper abdominal surgery was conducted. Patients were divided into two groups to receive either morphine 30 microg kg(1) (MB) or clonidine 2 microg kg(1) (CB) in bupivacaine 0.2% (1.25 ml kg(1)) for caudal analgesia. The duration of analgesia (FLACC scale) and sedation and side-effects such as vomiting, itching, respiratory depression, hypotension, and bradycardia were observed. RESULTS: The mean duration of analgesia was 16.5 (3.6) h in the CB group compared with 10.2 (2.3) h (P<0.01) in the MB group. Subjects who received clonidine (CB) were sedated for longer [7.1 (0.8) h] compared with the MB group [3.8 (0.7) h; P<0.01]. Vomiting was observed in 4% and 12% of subjects in the CB and MB groups, respectively. Sixteen per cent of subjects reported itching in the MB group (P=0.03), and none in the CB group. No hypotension, bradycardia, or respiratory depression was observed in any subjects. CONCLUSIONS: Caudal clonidine 2 microg kg(1) in bupivacaine 0.2% provides a longer duration of analgesia and sedation compared with caudal morphine 30 microg kg(1) in bupivacaine 0.2% without significant side-effects in children undergoing upper abdominal surgery.