Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.09.008
Brazilian Journal of Anesthesiology
Scientific Article

Combination of clonidine-bupivacaine in caudal epidural anesthesia for hypospadias surgery in children: prospective, randomized, blind study

Associação clonidina-bupivacaína na anestesia peridural caudal para cirurgia de hipospádia em crianças: estudo prospectivo, randomizado, encoberto

Ana Cláudia Mota Bonisson; Magda Lourenço Fernandes; Guilherme Freitas Araújo; Fabrício Eduardo Vieira; Luíza Melo Noronha; Renato Santiago Gomez

http://dx.doi.org/10.1016/j.bjane.2018.09.008 Braz J Anesthesiol, vol.69, n1, p.27-34, 2019
PDF English
PDF Português
Downloads: 0
Views: 677

Abstract

Abstract Background and objectives: The combination of clonidine with local anesthetic administered for epidural anesthesia via caudal route seems to improve the quality of postoperative analgesia, but with conflicting results. This study compared the postoperative analgesia of three different doses of clonidine combined with bupivacaine in caudal epidural anesthesia in children undergoing hypospadias repair. Methods: Eighty children aged 1-10 years, candidates for surgical repair of hypospadias, were randomly divided into four groups of 20 patients to receive general anesthesia combined with caudal epidural anesthesia with bupivacaine 0.165% alone or in combination with 1, 2 or 3 µg.kg- 1 of clonidine. The primary outcome was morphine consumption in the first 24 h postoperatively. Mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, time to awakening, pain severity (FLACC scale), level of sedation (RAMSAY), duration of analgesia, and occurrence of adverse effects were also compared. Results: Intraoperatively, there was no difference between groups regarding mean arterial pressure, heart rate, end-tidal concentration of sevoflurane, and time to awakening. Postoperative morphine consumption and pain severity were similar between groups, but the group receiving clonidine (3 µg.kg-1) had lower heart rate and higher sedation level than the group receiving bupivacaine alone. Conclusions: The combination of clonidine at doses of 1, 2 or 3 µg.kg-1 with bupivacaine 0.16% via caudal epidural route did not alter the consumption of morphine in the early postoperative period of children undergoing hypospadias repair.

Keywords

Post-operative pain, Caudal epidural anesthesia, Analgesia, Bupivacaine, Clonidine

Resumo

Resumo Justificativa e objetivos: A associação de clonidina ao anestésico local administrado por via peridural caudal parece melhorar a qualidade da analgesia pós-operatória, mas com resultados conflitantes. Este estudo comparou a analgesia pós-operatória de três diferentes doses de clonidina associada à bupivacaína na anestesia peridural caudal em crianças submetidas à correção de hipospádia. Método: Oitenta crianças entre um e dez anos, candidatas à correção cirúrgica de hipospádia, foram divididas, aleatoriamente, em quatro grupos de 20 pacientes para receber anestesia geral associada à anestesia peridural caudal com bupivacaína 0,166% isolada ou associada a 1, 2 ou 3 µg.Kg-1 de clonidina. Como desfecho principal avaliou-se o consumo de morfina nas primeiras 24 horas de pós-operatório. Compararam-se também pressão arterial média, frequência cardíaca, concentração expirada de sevoflurano, tempo de despertar da anestesia, intensidade da dor pela escala FLACC, nível de sedação (Ramsay), tempo de duração da analgesia e ocorrência de efeitos adversos. Resultados: No transoperatório, não houve diferença entre os grupos quanto à pressão arterial média, frequência cardíaca, concentração expirada de sevoflurano e ao tempo de despertar. No pós-operatório, o consumo de morfina e a intensidade da dor foram similares entre os grupos, mas o grupo que recebeu 3 µg.Kg-1 de clonidina apresentou menor frequência cardíaca e maior sedação do que o grupo que recebeu somente bupivacaína. Conclusões: A associação de clonidina nas doses de 1, 2 ou 3 µg.Kg-1 à bupivacaína 0,166% por via peridural caudal não alterou o consumo de morfina no pós-operatório imediato de crianças submetidas à correção de hipospádia.

Palavras-chave

Dor pós-operatória, Anestesia peridural caudal, Analgesia, Bupivacaína, Clonidina

References

Morton NS. Pain assessment in children. Paediatr Anaesth. 1997;4:26772.

Tsui BC, Berde CB. Caudal analgesia and anesthesia techniques in children. Curr Opin Anaesthesiol. 2005;18:283-8.

Wolf AR, Valley RD, Fear DW. Bupivacaine for caudal analgesia in infants and children: The optimal effective concentration. Anesthesiology. 1988;69:102-6.

Fernandes ML, Pires KCC, Tibúrcio MA. Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study. J Anesth. 2011;26:213-8.

De Beer DA, Thomas ML. Caudal additives in children - solutions or problems?. Br J Anaesth. 2003;90:487-98.

Schnabel A, Poepping DM, Pogatzki-Zahn EM. Efficacy and safety of clonidine as additive for caudal regional anesthesia: a quantitative systematic review of randomized controlled trials. Paediatr Anaesth. 2011;21:1219-30.

OF A.S. ASA New classification of physical status. Anesthesiology. 1963;24:111.

Ramsay MA, Savege TM, Simpson BR. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-9.

Merkel SI, Shayevitz J. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293-7.

Feestini F, Dini D, Neri C. Control of postoperative pain in children undergoing hypospadias surgery: quasi-experimental controlled trial. Assist Inferm Ric. 2008;27:197-201.

Sanwatsarkar S, Kapur S, Khan N. Comparative study of caudal clonidine and midazolam added to bupivacaine during infra-umbilical surgeries in children. J Anaesthesiol Clin Pharmacol. 2017:3324-47.

Hong JY, Han SW, Kim WO. Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchiopexy. Br J Anaesth. 2010;105:506-10.

Klimscha W, Chiari A, Michalek-Sauberer A. The efficacy and safety of a clonidine/bupivacaine combination in caudal blockade for pediatric hernia repair. Anesth Analg. 1998;86:54-61.

Yildiz TS, Korkmaz F, Solak M. Clonidine addition prolongs the duration of caudal analgesia. Acta Anaesthesiol Scand. 2006;50:501-4.

Sharpe P, Klein JR, Thompson JP. Analgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine. Paediatr Anaesth. 2001;11:695-700.

Priolkar S, D'Souza SA. Efficacy and safety of clonidine as an adjuvant to bupivacaine for caudal analgesia in paediatric infra-umbilical surgeries. J Clin Diagn Res. 2016;10:UC13-6.

De May JC, Strobet J, Poelaert J. The influence of sufentanil and/or clonidine on the duration of analgesia after caudal block for hypospadias repair surgery in children. Eur J Anaesthesiol. 2000;17:379-82.

Hansen TG, Henneberg SW, Walther-Larsen S. Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double-blind study. Br J Anaesth. 2004;92:223-7.

Luz G, Innerhofer P, Oswald E. Comparison of clonidine 1 microgram kg-1 with morphine 30 micrograms kg-1 for post-operative caudal analgesia in children. Eur J Anaesthesiol. 1999;16:42-6.

Taicher BM, Routh JC, Eck JB. The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Paediatr Anaesth. 2017;27:688-94.

5dcafa3f0e8825773403b87b rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections