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

Nicola Disma, Geoff Frawley, Leila Mameli, Angela Pistorio, O. D C Alberighi, Giovanni Montobbio, Pietro Tuo

Research output: Contribution to journalArticlepeer-review


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
Issue number2
Publication statusPublished - Feb 2011


  • 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


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