title: Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study.
abstract: OBJECTIVE
  We aimed to evaluate postoperative analgesia of morphine, or clonidine, or morphine plus clonidine, added to caudal bupivacaine in children undergoing infra-umbilical urological and genital procedures.
  
  
  METHODS
  Eighty patients aged 1-10 years were prospectively enrolled. After the induction of general anesthesia, the patients were randomized to four caudal anesthesia groups: Group B (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000); Group BM (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg); Group BC (bupivacaine 0.166% with epinephrine 1:600,000 plus clonidine 1.0 μg/kg), and Group BMC (bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg and clonidine 1.0 μg/kg). Duration of surgery, emergence time, postoperative pain score measured by the face, legs, activity, cry, consolability (FLACC) scale, postoperative analgesia time, and overall use of rescue analgesics were recorded.
  
  
  RESULTS
  The FLACC pain score (6, 12, and 24 h after the surgery) and the number of patients requiring analgesics during the first 24 h of the postoperative period were higher in Groups B and BC than in Groups BM and BMC (p < 0.05). The incidence of pruritus and urinary retention was comparable between the groups (p > 0.05). However, the incidence of postoperative nausea and vomiting (PONV) was higher in Groups BM (35%) and BMC (25%) than in Groups B (5%) and BC (5%) (p < 0.05).
  
  
  CONCLUSIONS
  To conclude, we showed that 20 μg/kg of morphine added to caudal bupivacaine 0.166% plus epinephrine 1:600,000 decreased the use of analgesics in the postoperative period, although it was associated with an increased incidence of PONV. However, the addition of clonidine (1.0 μg/kg) to caudal bupivacaine provided no additional clinical benefit over bupivacaine alone.
authors.affiliation: Department of Anesthesiology and Surgery, Santa Casa de Misericórdia, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Magda L
authors.initials: ML
authors.lastname: Fernandes
authors.forename: Kleber C C
authors.initials: KC
authors.lastname: Pires
authors.forename: Moacir A
authors.initials: MA
authors.lastname: Tibúrcio
authors.forename: Renato S
authors.initials: RS
authors.lastname: Gomez
mesh_terms: D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000763:Anesthesia, Caudal / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D009020:Morphine; D003000:Clonidine; D002045:Bupivacaine; D004837:Epinephrine