KUMJ | VOL. 10 | NO. 3 | ISSUE 39 | JUL-SEP, 2012
Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients
Singh J, Shah RS, Vaidya N, Mahato PK, Shrestha S, Shrestha BL
Abstract: Background
Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia
for providing intra- and postoperative analgesia. Several adjuvants have been used
to prolong the action of bupivacaine.
Objectives
To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and
duration of analgesia they produce when added with caudal bupivacaine by single
shot technique in children.
Methods
Eighty children, age one to ten years, undergoing sub-umbilical surgery, were
prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/
kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75
ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC)
or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg
(Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl
1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC
scale.
Results
The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32
min) than other three groups P < 0.05. The pain score assessed using FLACC scale
was compared between the four groups, and children in Group BC had lower pain
scores, which was statistically significant. The requirement of rescue medicine was
lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for
caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia
of bupivacaine, without any side effects in compare to fentanyl or ketamine.
Conclusion
We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for
caudal analgesia and administered as a 0.75 ml/kg mixture in children, for subumbilical
surgery, significantly prolongs the duration of post-operative analgesia
when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75
ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25%
bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone,
without any side effects.
Keyword : Bupivacaine, caudal analgesia, clonidine, fentanyl, ketamine, post-operative analgesia, sub-umbilical surgery
