Analgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine.
BACKGROUND
Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain.


METHODS
We compared the effect of clonidine, 1 and 2 microg x kg(-1), added to bupivacaine (1.25 mg x kg(-1)) with that of bupivacaine alone in 75 male children undergoing elective circumcision.


RESULTS
There was a trend towards increasing duration of analgesia with increasing dose of clonidine [group B (bupivacaine) 280.7 (171.6) min, C1 (bupivacaine + clonidine 1 microg x kg(-1)) 327.8 (188.3) min and C2 (bupivacaine + clonidine 2 microg x kg(-1)) 382.0 (200.6) min], although this difference was not statistically significant. Mean time to arousal from anaesthesia was significantly prolonged with clonidine 2 microg kg(-1) (group C2 21.3 (13-36) min, group C1 14.0 (6-25) min and group B 14.4 (2-32) min. Supplementary analgesic requirements and incidence of adverse effects were low, with no differences between the groups.


CONCLUSIONS
For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 microg x kg(-1) to low volume (0.5 ml x kg(-1)) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision.
Sharpe
P
P
University Department of Anaesthesia and Pain Management, Leicester Royal Infirmary, Leicester, UK. ps46@le.ac.uk
Klein
J R
JR
Thompson
J P
JP
Rushman
S C
SC
Sherwin
J
J
Wandless
J G
JG
Fell
D
D
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000698:Analgesia; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D002045:Bupivacaine; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D003000:Clonidine / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control
D000316:Adrenergic alpha-Agonists; D000779:Anesthetics, Local; D003000:Clonidine; D002045:Bupivacaine