Post Operative Epidural Analgesia in Pediatric Abdominal Surgery: Comparison of Clonidine and Dexmedetomidine as an Adjuvant

Background: A Caudal epidural block is considered as one of the most common regional techniques in pediatric anesthesia. The latest addition to the group of adjuvants for caudal analgesia is α2 agonists namely Clonidine and Dexmedetomidine. This study includes a comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in caudal epidural anesthesia for postoperative pain relief in the pediatric population. Methods: This study was performed on 60 children, aged 1 year to 6 years, of ASA physical status I and II, undergoing elective infra-umbilical surgeries under general anesthesia. The patients were assigned randomly into two groups of 30 patients each, caudal epidural was given in all patients according to their group, after giving general anaesthesia. Group A (n=30) - patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Dexmedetomidine. Group B (n=30)- patient received 0.125% bupivacaine (1ml/kg) with 0.5mcg/kg Clonidine. The patients were observed postoperatively for the duration and effect of caudal analgesia, (using the CHEOPS Score - Children’s Hospital of Eastern Ontario Pain Scale), frequency and total dose of supplementary analgesic required, sedative effect (Modified Ramsay Sedation Score), perioperative hemodynamic parameters, and complications. Results: The duration of Caudal analgesia without the need of supplementary analgesic is significantly higher in dexmedetomidine group (743 ± 73.6 min) than clonidine group (181.7 ± 53.60 min) and the total dose of supplementary analgesic (Inj. Paracetamol 15mg/kg i.v) required is significantly higher in clonidine group (491.5 ± 134.55 mg) as compared to dexmedetomidine group (236.5 ± 113.68 mg). Conclusion: Addition of dexmedetomidine (0.5 mcg/kg) to caudal 0.125% bupivacaine (1ml/kg) produces a significantly longer duration of postoperative analgesia, less frequency, and dose of rescue analgesic required for postoperative analgesia in children, aged between 1 to 6 yrs as compared to a similar dose of clonidine used in caudal epidural for infra umbilical surgeries.