EXPLORING ANALGESIC EFFICACY OF DEXMEDETOMIDINE AND CLONIDINE AS ADJUVANTS IN CAUDAL EPIDURAL BLOCK WITH 0.2% ROPIVACAINE FOR PEDIATRIC LOWER ABDOMINAL SURGERIES

MANOJ KUMAR GUPTA; SANJAYA KUMAR GUPTA; VIKRAM SINGH RATHORE; DIVYA CHANDRA

doi:10.22159/ajpcr.2025v18i10.55284

Authors

MANOJ KUMAR GUPTA Department of Anaesthesiology, Indian Naval Hospital Ship Sanjivani, Kochi, Kerala, India. https://orcid.org/0000-0003-1772-5713
SANJAYA KUMAR GUPTA Department of Anaesthesiology, Military Hospital, Prayagraj, Uttar Pradesh, India https://orcid.org/0000-0002-0554-6008
VIKRAM SINGH RATHORE Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.
DIVYA CHANDRA Department of Anaesthesiology, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India. https://orcid.org/0009-0008-8561-412X

DOI:

https://doi.org/10.22159/ajpcr.2025v18i10.55284

Keywords:

Analgesia, Pain Management, Clonidine, Dexmedetomidine, Caudal Anesthesia

Abstract

Objectives: Effective post-operative pain management is crucial in pediatric anesthesia. Challenges such as distinguishing pain from hunger or fear in younger children and concerns about respiratory depression with opioid use have often resulted in inadequate pain control in this ppulation. Recent studies have highlighted the importance of addressing pediatric pain with the same seriousness as in adults, as pain in children can lead to similar physiological and psychological consequences. This prospective, randomized study aimed to compare the efficacy and safety of caudal ropivacaine with dexmedetomidine versus clonidine for post-operative analgesia in pediatric patients undergoing lower abdominal surgeries. In addition, we evaluated hemodynamic and respiratory changes in both treatment groups and monitored for any complications.

Methods: A comparative prospective study was conducted involving 100 American Society of Anaesthesiologists status I or II male patients aged 2–8 years undergoing lower abdominal surgeries from January 2012 to December 2013. Patients were randomly assigned to two groups and received caudal epidural analgesia following general anesthesia induction. Group A received 0.2% ropivacaine (1 mL/kg) plus clonidine 1 μg/kg, while Group B received 0.2% ropivacaine (1 mL/kg) plus dexmedetomidine 1 μg/kg. Intraoperative monitoring included heart rate (HR), mean arterial pressure (MAP), oxygen saturation, electrocardiogram, and end-tidal carbon dioxide levels. Post-operative sedation scores and Visual Analog Scale scores for pain relief were recorded.

Results: Statistical analysis using the Statistical Package for the Social Sciences release 12.0 showed a significant increase in HR and MAP at intubation, which declined after caudal block. There was a decrease in HR and MAP from baseline to minimum, but no intervention was required. Both groups exhibited similar post-operative sedation levels, with a significant increase in duration of post-operative analgesia in Group B.

Conclusion: In conclusion, as a caudal adjuvant to 0.2% ropivacaine, dexmedetomidine at a dosage of 1 μg/kg provided significantly longer post-operative analgesia and improved hemodynamic stability compared to clonidine 1μg/kg, without excessive sedation or major side effects.

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References

1. Hurley RW, Murphy JD, Wu CL. Acute postoperative pain. In: Miller RD, Eriksson L, editors. Fleisher Editors Miller’s Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015. p. 29-74.

2. Krane EJ. Delayed respiratory depression in a child after caudal epidural morphine. Anesth Analg. 1988 Jan;67(1):79-82. doi: 10.1213/00000539-198801000-00017, PMID 3337350

3. Lönnqvist PA. Adjuncts to caudal block in children--quo vadis? Br J Anaesth. 2005 Oct;95(4):431-33. doi: 10.1093/bja/aei221, PMID 16155039

4. Cook B, Doyle E. The use of additives to local anaesthetic solutions for caudal epidural blockade. Paediatr Anaesth. 1996;6(5):353-9. doi: 10.1046/j.1460-9592.1996.d01-3.x, PMID 8880814

5. Ivani G, Lampugnani E, Torre M, Calevo Maria G, DeNegri P, Borrometi F, et al. Comparison of ropivacaine with bupivacaine for paediatric caudal block. Br J Anaesth. 1998 Aug;81(2):247-8. doi: 10.1093/bja/81.2.247, PMID 9813532

6. Kroin JS, Buvanendran A, Beck DR, Topic JE, Watts DE, Tuman KJ. Clonidine prolongation of lidocaine analgesia after sciatic nerve block in rats is mediated via the hyperpolarization-activated cation current, not by alpha-adrenoreceptors. Anesthesiology. 2004 Aug;101(2):488-94. doi: 10.1097/00000542-200408000-00031, PMID 15277933

7. Wu CT, Jao SW, Borel CO, Yeh CC, Li CY, Lu CH, et al. The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery. Anesth Analg. 2004 Aug;99(2):502-9. doi: 10.1213/01. ANE.0000117146.46373.51, PMID 15271731

8. De Kock M. Site of hemodynamic effects of alpha 2-adrenergic agonists. Anesthesiology. 1991 Oct;75(4):715-6. doi: 10.1097/00000542- 199110000-00046, PMID 1928792

9. Grewal A. Dexmedetomidine: New avenues. J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):297-302. doi: 10.4103/0970-9185.83670, PMID 21897496, PMCID PMC3161450

10. Parameswari A, Dhev AM, Vakamudi M. Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery. Indian J Anaesth. 2010 Sep;54(5):458-63. doi: 10.4103/0019-5049.71047, PMID 21189886, PMCID PMC2991658

11. Gupta S, Pratap V. Addition of clonidine or dexmedetomidine to ropivacaine prolongs caudal analgesia in children. Indian J Pain. 2014;28(1):36-41. doi: 10.4103/0970-5333.128892

12. Anand VG, Kannan M, Thavamani A, Bridgit MJ. Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries. Indian J Anaesth. 2011 Jul;55(4):340-6. doi: 10.4103/0019-5049.84835, PMID 22013248, PMCID PMC3190506

13. El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth. 2009 Aug;103(2):268-74. doi: 10.1093/bja/aep159, PMID 19541679

14. Koul A, Pant D, Sood J. Caudal clonidine in day-care paediatric surgery. Indian J Anaesth. 2009 Aug;53(4):450-4. PMID 20640207, PMCID PMC2894500

15. Neogi M, Bhattacharjee DP, Dawn S, Chatterjee N. A comparative study between clonidine and dexmedetomidine used as adjuncts to ropivacaine for caudal analgesia in paediatric patients. J Anaesthesiol Clin Pharmacol. 2010 Apr-Jun;26(2):149-52. doi: 10.4103/0970- 9185.74900

16. Joshi W, Connelly NR, Freeman K, Reuben SS. Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade. Paediatr Anaesth. 2004 Jun;14(6):483-6. doi: 10.1111/j.1460- 9592.2004.01229.x, PMID 15153211

17. Sagar TV, Byndoor Y, PM. To comparedexmedetomidine with clonidine as adjuvants to ropivacaine in epidural anesthesia in patients undergoing lower abdominal surgeries. Asian J Pharm Clin Res. 2023 Jun 7;16(6):116-9.