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Clonidine or Tramadol Added to Bupivacaine for Prolonging Post Operative Caudal Epidural Analgesia in Children

Kulkarni Shrinivas, Associate Professor, Department of Anesthesiology, Mysore Medical College & Research Institute, Mysore, Karnataka 570001. , Kulkarni Shrinivas1 , Shreeharsha M.2 , Gurudatt C.L.3 , Shradha Surana4

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Indian Journal of Anesthesia and Analgesia 5(1):p 85-92, January-February 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5118.13

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Abstract

Background and Objectives: Caudal epidural analgesia is most popular and commonly performed regional blocks in paediatric anaesthesia.To prolongpost operative analgesia local anesthetics have to be combined with adjuvants. Adjuvants like narcotics, alpha-2 agonists, epinephrine, tramadol, neostigmine, and s-ketamine have been studied. Of these clonidine and tramadol are drugs with minimal side effects. Hence study performed with the primary objective being, comparing the two drugs when combined with bupivacaine regarding prolongation of the post operative analgesia Methods: The study was conducted among Ninety children in the age group of 2 to 8 years posted for elective sub-umbilical surgical procedures lasting less than one hour, after obtaining ethical committee clearance.They were divided into 3 groups, 30 each. Group C received 0.5ml/kg of 0.25% Bupivacaine with 0.1ml/kg of normalsaline, Group BC 0.5ml/kg of 0.25% Bupivacaine with 1g/kg of Clonidine(0.1ml/kg) and Group BT 0.5ml/kg of 0.25% Bupivacaine with 1mg/kg of tramadol (0.1ml/kg). The various parameters studied were duration of post operative analgesia, haemodynamic changes and incidence of side-effects. Results: The mean duration of analgesia was 539.83±19.32 minutes inclonidine group which was significantly longer than 412.00±26.05 minutes in tramadol group. The requirement of rescue analgesic was also lesser in theclonidine group. Incidence of post-operative nausea andvomiting was slightly higher in the tramadol group. Conclusion: Addition of clonidine in the dose of 1g/kg andtramadol 1 mg/kg to 0.25% bupivacaine (0.5ml/kg) increased the duration of postoperativeanalgesia and clonidine provided a longer durationwith lesssideeffects than tramadol.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5118.13

Keywords

Caudal; Bupivacaine; Clonidine; Tramadol. 

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