THE EFFICACY AND SAFETY OF A CLONIDINE BUPIVACAINE COMBINATION IN CAUDAL BLOCKADE FOR PEDIATRIC HERNIA REPAIR/

We evaluated the analgesic efficacy and hemodynamic and respiratory sa fety of clonidine when added to bupivacaine for caudal blocks in 58 ch ildren aged 38 +/- 2 mo (mean +/- SEM). Patients scheduled for ambulat ory hernia repair were randomly given a caudal injection (0.75 mL/kg) of either saline placebo (P group), bupivacaine, 0.25% (B group), bupi vacaine plus epinephrine 1:200,000 (BE group), bupivacaine plus clonid ine 1 mu g/kg (BC1 group), or bupivacaine plus clonidine 2 mu g/kg (BC 2 group). Postoperative measurements included duration of analgesia, h emodynamics, and respiratory monitoring for 6 h. Thereafter, parents a ssessed their child's analgesic requirements at home every 3 h for 18 h. The duration of analgesia (median [range]) was significantly longer (P < 0.05) in the BC1 and BC2 groups (360 [270-360] min and 360 [355- 360] min, respectively) compared with the P (77[45-190]), B (346[105-3 60]), or BE group (300[75-360]). Similarly, the BC1 and BC2 groups req uired less additional analgesic within the first 24 h. All groups show ed a significant decrease in mean arterial pressure compared with base line values, but the differences among the groups were not significant . Bradycardia and respiratory depression were not observed. Clonidine 1 and 2 mu g/kg can be safely added to bupivacaine caudal blockade in small children for ambulatory hernia repair to achieve an increased du ration of analgesia compared with bupivacaine alone or bupivacaine plu s epinephrine. Implications: The addition of clonidine, an antihyperte nsive drug with analgesic properties, to local anesthetics in caudal b locks prolongs postoperative pain relief and reduces the need for addi tional pain treatment in children after hernia operation.