Ropivacaine-clonidine combination for caudal blockade in children.
BACKGROUND
Adding clonidine to weak ropivacaine solutions (<0.2%) could potentially enhance analgesia as well as further reduce the risk for unwanted motor blockade. The aim of the present study was to compare the postoperative pain-relieving quality of a ropivacaine 0.1%-clonidine mixture to that of plain ropivacaine 0.2% following caudal administration in children.


METHODS
In a prospective, observer-blinded fashion, 40 ASA 1 paediatric patients undergoing subumbilical surgery were randomly allocated to receive a caudal injection of either plain ropivacaine 0.2% (1 ml/kg) (R0.2) or a mixture of ropivacaine 0.1% with clonidine 2 microg/kg (1 ml/kg) (R0.1C). Objective pain scale score and need for supplemental analgesia were used to evaluate analgesia during the first 24 h postoperatively. Residual postoperative sedation was also assessed.


RESULTS
A significantly higher number of patients in the R0.1C group (18/20) could be managed without supplemental analgesia during the first 24 h postoperatively compared to the R0.2 group (11/20) (P=0.034). Both the degree and the duration of postoperative sedation was similar in both groups. No signs of postoperative motor blockade were observed.


CONCLUSIONS
The combination of clonidine (2 microg/kg) and ropivacaine 0.1% is associated with an improved quality of postoperative analgesia compared to plain 0.2% ropivacaine. The improved analgesic quality of the clonidine-ropivacaine mixture is achieved without causing any significant degree of postoperative sedation.
Ivani
G
G
Department of Anaesthesia, Regina Margherita Children's Hospital, Turin, Italy. gioivani@ipsnet.it
De Negri
P
P
Conio
A
A
Amati
M
M
Roero
S
S
Giannone
S
S
Lönnqvist
P A
PA
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000577:Amides / Q000008:administration & dosage*; D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010149:Postoperative Pain; D011446:Prospective Studies; D000077212:Ropivacaine
D000759:Adjuvants, Anesthesia; D000316:Adrenergic alpha-Agonists; D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D003000:Clonidine