title: A comparison of epidural bupivacaine-fentanyl and bupivacaine-clonidine in children undergoing the Nuss procedure.
abstract: The administration of epidural opioids, though effective for producing analgesia, has severe side effects in most patients. It is unknown whether clonidine can effectively replace opioids and cause fewer side effects. We compared, in this randomized trial, the incidence of vomiting and pruritus as well as the analgesic profile of three different combinations of bupivacaine, fentanyl, and clonidine administered epidurally in patients undergoing the Nuss procedure: bupivacaine + fentanyl, bupivacaine + clonidine, bupivacaine + fentanyl + clonidine. The incidence of side effects was significantly less in the bupivacaine + clonidine group (33%) compared with the bupivacaine + fentanyl (92%) and bupivacaine + fentanyl + clonidine (73%) groups (P = 0.004). Quality of postoperative analgesia was similar in the three groups. No significant complications were observed. In conclusion, clonidine is an effective and safe alternative to epidural opioids.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA. cucchiaro@email.chop.edu
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cucchiaro
authors.forename: Scott N
authors.initials: SN
authors.lastname: Adzick
authors.forename: John B
authors.initials: JB
authors.lastname: Rose
authors.forename: Lynne
authors.initials: L
authors.lastname: Maxwell
authors.forename: Mehernoor
authors.initials: M
authors.lastname: Watcha
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003000:Clonidine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D003000:Clonidine; D005283:Fentanyl; D002045:Bupivacaine