A prospective randomised controlled study comparing intra-operative and post-operative analgesic efficacy of clonidine with bupivacaine for caudal block in paediatric surgical procedures at Kenyatta National Hospital
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Date
2006Author
Momanyi, Kennedy O
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Caudal analgesia is the most popular and commonly used regional block in
paediatric surgery. It continues to offer a safe and effective intra and postoperative
analgesia for many surgical procedures in the region of the umbilicus
and below. The use of local anaesthetics in combination with opioids has been
demonstrated to improve caudal analgesia in children but has also been
associated with side effects such as nausea and vomiting, pruritus, urinary
retention, and potentially life threatening respiratory depression. Clonidine, an
alpha, agonist has been used effectively for the treatment of acute and chronic
pain. It has been shown to provide analgesia of variable efficacy and duration
and to potentiate postoperative analgesia when used in combination with local
anaesthetics or opioids via extradural and intradural routes. Furthermore, it
lacks side effects that are associated with the use of systemic and spinal
opioids but does demonstrate adverse effects including sedation, hypotension,
and bradycardia.
This study was designed to compare the analgesic efficacy and incidences of
side effects of clonidine with bupivacaine. It was a prospective randomized
controlled study, which was carried out at Kenyatta National Hospital (KNH)
over a period of two months. The study subjects were the paediatric patients
aged two months to thirteen years scheduled for elective surgery. Statistical
analysis was performed using chi square test for nominal data. Continuous data
was compared using Kruskal-wallis one-way analysis of variance (ANOV A).
P<0.05 was considered significant.
Sixty patients aged 2 months to 13 years were randomly allocated to three
equal groups to receive 0.25% bupivacaine 1ml kg" body weight (group B),
-j clOl2-idine2~Lkg" body weight (group C) and 0.12'5% bupivacaine 1ml kg'
body weight combined with clonidine 1).1 kg' body weight (group BC). The
median time for duration of analgesia was 5.18 hours for group B, 6.17 hours
for group C and 8.03 hours for group BC (P<O.OOl).There was a significant
difference in the incidence of side effects between the three groups. The
median time to first micturition and ambulation was significantly higher in
group B as compared to groups C and BC (P<O.OOI). The incidence of
sedation was higher in groups BC and C as compared to group B. This resulted
partly from the longer duration of analgesia provided by clonidine and the
clonidine bupivacaine mixture as well as the sedative effect of clonidine. It
was concluded that the analgesic efficacy of clonidine is better than
bupivacaine and that a combination of clonidine and bupivacaine in lowered
dosages improves the efficacy of caudal analgesia in children with reduced
incidences of side effects.
Citation
M.Med (Anaesthesia) ThesisSponsorhip
University of NairobiPublisher
Department of Medicine, University of Nairobi
Description
Master of Medicine Thesis