Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study.

Publisher: Springer International for the Japan Society of Anesthesiology Country of Publication: Japan NLM ID: 8905667 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1438-8359 (Electronic) Linking ISSN: 09138668 NLM ISO Abbreviation: J Anesth Subsets: MEDLINE

Publication: Tokyo : Springer International for the Japan Society of Anesthesiology
Original Publication: [Tokyo] : Japan Society of Anesthesiology, [1987-

Analgesics/*administration & dosage ; Anesthesia, Caudal/*methods ; Anesthetics, Local/*administration & dosage ; Bupivacaine/*administration & dosage ; Clonidine/*administration & dosage ; Morphine/*administration & dosage ; Pain, Postoperative/*drug therapy; Analgesics/adverse effects ; Anesthesia, Caudal/adverse effects ; Anesthesia, General/methods ; Anesthetics, Local/adverse effects ; Bupivacaine/adverse effects ; Child ; Child, Preschool ; Clonidine/adverse effects ; Double-Blind Method ; Epinephrine/administration & dosage ; Female ; Humans ; Male ; Morphine/adverse effects ; Pain Measurement/methods ; Prospective Studies

Purpose: We aimed to evaluate postoperative analgesia of morphine, or clonidine, or morphine plus clonidine, added to caudal bupivacaine in children undergoing infra-umbilical urological and genital procedures.
Methods: Eighty patients aged 1-10 years were prospectively enrolled. After the induction of general anesthesia, the patients were randomized to four caudal anesthesia groups: Group B (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000); Group BM (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg); Group BC (bupivacaine 0.166% with epinephrine 1:600,000 plus clonidine 1.0 μg/kg), and Group BMC (bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg and clonidine 1.0 μg/kg). Duration of surgery, emergence time, postoperative pain score measured by the face, legs, activity, cry, consolability (FLACC) scale, postoperative analgesia time, and overall use of rescue analgesics were recorded.
Results: The FLACC pain score (6, 12, and 24 h after the surgery) and the number of patients requiring analgesics during the first 24 h of the postoperative period were higher in Groups B and BC than in Groups BM and BMC (p < 0.05). The incidence of pruritus and urinary retention was comparable between the groups (p > 0.05). However, the incidence of postoperative nausea and vomiting (PONV) was higher in Groups BM (35%) and BMC (25%) than in Groups B (5%) and BC (5%) (p < 0.05).
Conclusion: To conclude, we showed that 20 μg/kg of morphine added to caudal bupivacaine 0.166% plus epinephrine 1:600,000 decreased the use of analgesics in the postoperative period, although it was associated with an increased incidence of PONV. However, the addition of clonidine (1.0 μg/kg) to caudal bupivacaine provided no additional clinical benefit over bupivacaine alone.

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0 (Analgesics)
0 (Anesthetics, Local)
76I7G6D29C (Morphine)
MN3L5RMN02 (Clonidine)
Y8335394RO (Bupivacaine)
YKH834O4BH (Epinephrine)

Date Created: 20111214 Date Completed: 20121107 Latest Revision: 20220317

20250114

10.1007/s00540-011-1297-y

22159880