Epidural infusion of clonidine or clonidine plus ropivacaine for postoperative analgesia in children undergoing major abdominal surgery.
OBJECTIVE
To investigate the analgesic efficacy and safety of epidural infusion of clonidine in children undergoing major abdominal surgery.


METHODS
Randomized open-label study.


METHODS
Postoperative anesthetic unit and pediatric ward of a metropolitan hospital.


METHODS
Forty children aged 0 to 3 years undergoing major abdominal surgery.


METHODS
Children were randomly allocated to receive a 24-hour epidural infusion of clonidine 1 microg.mL(-1) at rate of 0.2 mL.kg -1.h -1 preceded by a bolus of 2 microg.kg -1 (CLON group) or a mixture of clonidine 1 microg.mL -1 and ropivacaine 0.1% at rate of 0.2 mL.kg -1.h -1. Both groups received intravenous (IV) ketoprofen 2 mg.kg -1 every 8 hours. Breakthrough pain was treated with IV tramadol 1 mg.kg(-1).


METHODS
Tramadol requirement, sedation and respiratory and hemodynamic changes were measured.


RESULTS
Approximately 77% and 59.3% of the CLON and CLON+ROPIV groups, respectively, required no tramadol or only one dose over a 24-hour period. Except for those patients who exhibited frequent coughing during the night (4 and 5 patients in the CLON and CLON+ROPIV groups, respectively), no study patients required an analgesic and all had good sleep quality during the first night. Sedation and decreased systolic blood pressure were observed after the clonidine bolus was given.


CONCLUSIONS
For children undergoing major abdominal surgery, the addition of epidural infusion of clonidine or clonidine plus ropivacaine to IV ketoprofen provided good analgesia quality for postoperative rest pain.
Klamt
Jyrson Guilherme
JG
Department of Biomechanics, Faculty of Medicine of São Paulo (University of São Paulo), Brazil. jgklamt@fmrp.usp.br
Garcia
Luis Vicente
LV
Stocche
Renato Mestriner
RM
Meinberg
Antonio C
AC
D000005:Abdomen / Q000601:surgery*; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D000077212:Ropivacaine; D014147:Tramadol / Q000627:therapeutic use
D000316:Adrenergic alpha-Agonists; D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D014147:Tramadol; D000077212:Ropivacaine; D003000:Clonidine