A comparative study of clonidine and dexmedetomidine as an adjuvant to levobupivacaine for caudal analgesia in children undergoing below umbilical surgeries: A randomized double-blind controlled trial
Shilpa Agarwal1, Siddarth Agrawal1, Geeta Kamal1, Anju Gupta2, Aikta Gupta1, Bhumika Kalra11Department of Anesthesiology, Chacha Nehru Bal Chikitsalya Children Hospital, Delhi, India2Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Delhi, India
Objectives: Dexmedetomidine and clonidine have been studied separately as adjuvants with levobupivacaine, but there is no literature comparing the two drugs for caudal anesthesia in children. We compared the analgesic efficacy and adverse effects of clonidine and dexmedetomidine as adjuvants to levobupivacaine for caudal analgesia in children undergoing infraumbilical surgeries.
Methods: In this prospective randomized study, 100 pediatric patients (3 to 8 years) of either sex, scheduled for infraumbilical surgery, were randomly allocated to two equal groups in a double-blind manner. After induction of anesthesia using a standard technique, caudal anesthesia was administered using 0.2% levobupivacaine (1 ml/kg) with either 1 µg/kg dexmedetomidine (Group A) or 1 µg/kg clonidine (Group B). Hemodynamic parameters, motor block, degree of sedation, postoperative analgesia, use of rescue analgesics, and side effects were evaluated for 24 hours.
Results: The mean duration of analgesia in Group A (12.7±2.4 h) was higher than in Group B (10.6±2.2 h), which was statistically significant (p=0.000). The mean duration of sedation was higher in Group A, although it was statistically insignificant. Hemodynamic parameters were comparable in the two groups. No significant side effects were observed in the groups.
Conclusion: Dexmedetomidine (1 µg/kg) added to 0.2% levobupivacaine (1 ml/kg) for caudal block provides prolonged analgesia with better sedation scores when compared to clonidine (1 µg/kg) with 0.2% levobupivacaine (1 ml/kg) for below umbilical surgeries in pediatric patients, without increasing the incidence of adverse effects. Hence, we would recommend the use of 1 µg/kg dexmedetomi-dine as an adjuvant to 0.2% levobupivacaine.
Keywords: Analgesia, anesthesia, caudal, child, clonidine, dexmedetomidine, hemodynamics, levobupivacaine.
Manuscript Language: English