Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children

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Abstract

Background: Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose-response trial. Methods: A group of 120 children aged -1 of clonidine. The MLAC was determined according to a Dixon-Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. Results: The MLAC of caudal levobupivacaine was 0.106%, 0.077%, and 0.035% with 1, 2, and 3 μg·kg-1 of clonidine, respectively. There were significant dose-dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 μg·kg-1 of clonidine group. Conclusions: Clonidine produces a local anesthetic sparing effect with a dose-dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose-dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 μg·kg-1 of clonidine provides the optimum balance between improved analgesia and minimal side effects.

Original languageEnglish
Pages (from-to)128-135
Number of pages8
JournalPaediatric Anaesthesia
Volume21
Issue number2
DOIs
Publication statusPublished - Feb 2011

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Clonidine
Local Anesthetics
Analgesia
Caudal Anesthesia
Postoperative Nausea and Vomiting
levobupivacaine
Epidural Anesthesia
Postoperative Pain
Anesthetics
Anesthesia
Incidence

Keywords

  • anesthetic
  • anesthetic techniques
  • anesthetics local
  • caudal
  • clonidine
  • ED {50}
  • pharmacology
  • potency
  • regional
  • stereoisomers

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{2291bc6b33574e6ba9b9d9017ae8f443,
title = "Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children",
abstract = "Background: Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose-response trial. Methods: A group of 120 children aged -1 of clonidine. The MLAC was determined according to a Dixon-Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. Results: The MLAC of caudal levobupivacaine was 0.106{\%}, 0.077{\%}, and 0.035{\%} with 1, 2, and 3 μg·kg-1 of clonidine, respectively. There were significant dose-dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 μg·kg-1 of clonidine group. Conclusions: Clonidine produces a local anesthetic sparing effect with a dose-dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose-dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 μg·kg-1 of clonidine provides the optimum balance between improved analgesia and minimal side effects.",
keywords = "anesthetic, anesthetic techniques, anesthetics local, caudal, clonidine, ED {50}, pharmacology, potency, regional, stereoisomers",
author = "Nicola Disma and Geoff Frawley and Leila Mameli and Angela Pistorio and Alberighi, {O. D C} and Giovanni Montobbio and Pietro Tuo",
year = "2011",
month = "2",
doi = "10.1111/j.1460-9592.2010.03478.x",
language = "English",
volume = "21",
pages = "128--135",
journal = "Paediatric Anaesthesia",
issn = "1155-5645",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children

AU - Disma, Nicola

AU - Frawley, Geoff

AU - Mameli, Leila

AU - Pistorio, Angela

AU - Alberighi, O. D C

AU - Montobbio, Giovanni

AU - Tuo, Pietro

PY - 2011/2

Y1 - 2011/2

N2 - Background: Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose-response trial. Methods: A group of 120 children aged -1 of clonidine. The MLAC was determined according to a Dixon-Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. Results: The MLAC of caudal levobupivacaine was 0.106%, 0.077%, and 0.035% with 1, 2, and 3 μg·kg-1 of clonidine, respectively. There were significant dose-dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 μg·kg-1 of clonidine group. Conclusions: Clonidine produces a local anesthetic sparing effect with a dose-dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose-dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 μg·kg-1 of clonidine provides the optimum balance between improved analgesia and minimal side effects.

AB - Background: Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose-response trial. Methods: A group of 120 children aged -1 of clonidine. The MLAC was determined according to a Dixon-Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. Results: The MLAC of caudal levobupivacaine was 0.106%, 0.077%, and 0.035% with 1, 2, and 3 μg·kg-1 of clonidine, respectively. There were significant dose-dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 μg·kg-1 of clonidine group. Conclusions: Clonidine produces a local anesthetic sparing effect with a dose-dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose-dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 μg·kg-1 of clonidine provides the optimum balance between improved analgesia and minimal side effects.

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KW - anesthetic techniques

KW - anesthetics local

KW - caudal

KW - clonidine

KW - ED {50}

KW - pharmacology

KW - potency

KW - regional

KW - stereoisomers

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