title: The dose-response relationship for clonidine added to a postoperative continuous epidural infusion of ropivacaine in children.
abstract: Epidurally administered clonidine enhances the quality and duration of postoperative analgesia when it is used as an adjunct to local anesthetics in children. We investigated the dose-response relationship for epidural clonidine when added to a continuous postoperative epidural infusion of ropivacaine. By use of an observer-blinded design, 55 pediatric patients (1-4 yr old) were randomly given a postoperative epidural infusion of plain ropivacaine 0.1% 0.2 mg. kg(-1). h(-1) (Group R), ropivacaine 0.08% 0.16 mg. kg(-1). h(-1) plus clonidine 0.04 microg. kg(-1). h(-1) (Group RC1), ropivacaine 0.08% 0.16 mg. kg(-1). h(-1) plus clonidine 0.08 microg. kg(-1). h(-1) (Group RC2), or ropivacaine 0.08% 0.16 mg. kg(-1). h(-1) plus clonidine 0.12 microg. kg(-1). h(-1) (Group RC3). A clear dose-response relationship could be identified for a continuous infusion of epidural clonidine, with clonidine dosages in the 0.08-0.12 microg. kg(-1). h(-1) range providing improved postoperative analgesia (reduced Children's Hospital of Eastern Ontario pain score, increased time to first supplemental analgesic demand, and a reduced total number of doses of supplemental analgesics during the first 48 h after surgery). Analgesia was improved without any signs of increased sedation or other side effects. The adjunct use of epidural clonidine in the dosage range of 0.08-0.12 microg. kg(-1). h(-1) appears effective and safe for use in children.
  
  
  CONCLUSIONS
  The addition of clonidine (0.08-0.12 microg.kg(-1).h(-1))to a continuous epidural infusion of ropivacaine was found to improve postoperative pain relief in children. No clinically significant signs of sedation or other side effects were observed.
authors: Department of Anesthesia and Intensive Care, IRCCS H "Casa Sollievo della Sofferenza" S. Giovanni Rotondo (FG), Italy. pdenegri@libero.it
authors: P
authors: P
authors: De Negri
authors: G
authors: G
authors: Ivani
authors: C
authors: C
authors: Visconti
authors: P
authors: P
authors: De Vivo
authors: P A
authors: PA
authors: Lonnqvist
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000577:Amides; D015360:Analgesia, Epidural; D000758:Anesthesia; D000779:Anesthetics, Local; D002675:Child, Preschool; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use*; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine
chemical_list: D000316:Adrenergic alpha-Agonists; D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D003000:Clonidine