title: Optimum Concentration of Caudal Ropivacaine & Clonidine - A Satisfactory Analgesic Solution for Paediatric Infraumbilical Surgery Pain.
abstract: BACKGROUND
  Ropivacaine is amide local anaesthetic pure S(-)enantiomer of bupivacaine. Its duration of analgesia is similar to that of Bupivacaine (in equivalent doses) but the motor block is slower in onset, less intense, shorter in duration for a given level of sensory block with lesser cardiac side effects but addition of an adjuvant like clonidine which is an imidazoline derivative has been studied for its sedative, anxiolytic and analgesic properties.
  
  
  OBJECTIVE
  This study was aimed to show the optimum concentrations of Ropivacaine and Clonidine to maximize analgesia without side effects by evaluating its safety and efficacy.
  
  
  METHODS
  Sixty children aged 2-10 years of ASA grade 1, scheduled to undergo infraumbilical surgeries were randomly allocated to Group A & Group B of 30 each. Group A received 0.2% Ropivacaine with normal saline and Group B received 0.2% Ropivacaine and preservative free Clonidine 1μg/kg, the total volume of solution being 1ml/kg haemodynamic changes were monitored intraoperatively and haemodynamic parameters along with motor blockade, pain score and sedation score were assessed postoperatively.
  
  
  METHODS
  Done with unpaired student t and Mann-Whitney test.
  
  
  RESULTS
  The groups were comparable regarding demographic characterstics. The mean duration of analgesia was prolonged in group B (12+2.22 hours) than in group A (6.53+1.16 hours) with p-value <0.001 leading to less rescue analgesia in former group. None of the children in the groups had a pain score of ≥ 4 at the end of 2 hours. A 6.6% and 60% of group A children had score of ≥ 4 at the end of 4(th) & 6(th) hour respectively. None in Group B had a score of ≥ 4. At the end of 8(th) hour, only 6.6% of the children in Group B had a pain score of ≥ 4 whereas it was 33.33% in Group A which is statistically significant. No bradycardia or hypotension and no significant sedation.
  
  
  CONCLUSIONS
  Combination of Ropivacaine and Clonidine in the concentration used (0.2% ropivacaine and 1μg/kg of clonidine) can be optimal for postoperative analgesia in paediatric population.
authors.affiliation: Assistant Professor, Department of Anaesthesiology, Shridevi Institute of Medical sciences and Research Hospital , Tumkur, Karnataka, India .
authors.forename: Girish Chikkanayakanahalli
authors.initials: GC
authors.lastname: Narasimhamurthy
authors.affiliation: Assistant Professor, Department of Anaesthesiology, Shridevi Institute of Medical sciences and Research Hospital , Tumkur, Karnataka, India .
authors.forename: Muralidhara Danappa
authors.initials: MD
authors.lastname: Patel
authors.affiliation: Associate Professor, Department of Anaesthesiology, Goa Medical College , Goa-India .
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Menezes
authors.affiliation: Assistant Professor, Department of Anaesthesiology, Shridevi Institute of Medical sciences and Research Hospital , Tumkur, Karnataka, India .
authors.forename: Kavyashree Nagenahalli
authors.initials: KN
authors.lastname: Gurushanth
keywords: Motor block; Pain score; Postoperative analgesia; Sedation