title: Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery.
abstract: OBJECTIVE
  To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery.
  
  
  METHODS
  Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]).
  
  
  RESULTS
  There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001).
  
  
  CONCLUSIONS
  Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile.
authors.affiliation: Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.|Murdoch Childrens Research Institute, Melbourne, Vic., Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
authors.forename: George A
authors.initials: GA
authors.lastname: Chalkiadis
authors.affiliation: Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: David
authors.initials: D
authors.lastname: Sommerfield
authors.affiliation: Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Janette
authors.initials: J
authors.lastname: Low
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Vic., Australia.
authors.forename: Francesca
authors.initials: F
authors.lastname: Orsini
authors.affiliation: Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Dowden
authors.affiliation: Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Tay
authors.affiliation: Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Sueann
authors.initials: S
authors.lastname: Penrose
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Vic., Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.|Department of Orthopaedics, Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: Marinis
authors.initials: M
authors.lastname: Pirpiris
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Vic., Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.|Department of Orthopaedics, Royal Children's Hospital, Melbourne, Vic., Australia.
authors.forename: H Kerr
authors.initials: HK
authors.lastname: Graham
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000494:pharmacology*; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology*; D002547:Cerebral Palsy; D002648:Child; D003000:Clonidine / Q000008:administration & dosage / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000700:Analgesics; D003000:Clonidine; D005283:Fentanyl; D002045:Bupivacaine