title: Caudal Levobupivacaine Supplemented with Caudal or Intravenous Clonidine in Children Undergoing Infraumbilical Surgery: A Randomized, Prospective Double-blind Study.
abstract: BACKGROUND
  Caudal analgesia is the most popular regional anesthesia technique in pediatric population for intraoperative and postoperative analgesia. Clonidine, an α2agonist, prolongs analgesia without causing significant respiratory depression after systemic or neuraxial administration. However, the most beneficial route of its administration is still controversial. Thus, we compared the effects of caudal and intravenous (i.v) clonidine on postoperative analgesia produced by caudal levobupivacaine in children undergoing infraumbilical surgery.
  
  
  METHODS
  A comparative three group study was carried out in seventy-five pediatric patients who underwent elective surgery for infraumbilical procedures, under general anesthesia with caudal block. Group A (n= 25) received levobupivacaine 0.25% 1 mL/kg caudally and 5 mL of normal saline i.v, Group B (n= 25) received levobupivacaine 0.25% 1 mL/kg with 1 μg/kg clonidine caudally and 5 mL of normal saline i.v, and Group C (n= 25) received levobupivacaine 0.25% 1 mL/kg caudally and 1 μg/kg clonidine in 5 mL normal saline i.v. Postoperative pain was assessed for 24 h using the Children and Infants Postoperative Pain Scale Score. Ramsay sedation scale and modified Bromage scale were assessed at predetermined time intervals for sedation and motor blockade, respectively.
  
  
  RESULTS
  The mean duration of postoperative analgesia was significantly longer in Group B (16.68 ± 4.7 h) than in Group A (4.24 ± 1.42) and Group C (9.44 ± 3.88 h):P< 0.001. The number of patients not requiring rescue analgesia in Group B was 5, which was significantly higher than in Group C (one patient) and Group A (zero patient):P< 0.001. No motor blockade or sedation was observed in any of the groups.
  
  
  CONCLUSIONS
  Clonidine in a dose of 1 μg/kg added to 0.25% levobupivacaine for caudal analgesia significantly prolongs the duration of analgesia, without any side effects.
authors.affiliation: Department of Anaesthesiology, M S Ramaiah Medical College, Bengaluru, Karnataka, India.
authors.forename: Laxmi Ramya
authors.initials: LR
authors.lastname: Potti
authors.affiliation: Department of Anaesthesiology, M S Ramaiah Medical College, Bengaluru, Karnataka, India.
authors.forename: Yatish
authors.initials: Y
authors.lastname: Bevinaguddaiah
authors.affiliation: Department of Anaesthesiology, M S Ramaiah Medical College, Bengaluru, Karnataka, India.
authors.forename: S
authors.initials: S
authors.lastname: Archana
authors.affiliation: Department of Anaesthesiology, M S Ramaiah Medical College, Bengaluru, Karnataka, India.
authors.forename: Vinayak Seenappa
authors.initials: VS
authors.lastname: Pujari
authors.affiliation: Department of Anaesthesiology, M S Ramaiah Medical College, Bengaluru, Karnataka, India.
authors.forename: C Manjunath
authors.initials: CM
authors.lastname: Abloodu
keywords: Analgesia; caudal anesthesia; clonidine; levobupivacaine