COMPARITIVE STUDY OF DEXMEDETOMIDINE AND CLONIDINE USED AS ADJUVANTS IN CAUDAL ANAESTHESIA FOR POST OPERATIVE ANALGESIA IN PAEDIATRIC PATIENTS

Ankit Singh; Neelesh Nema

Volume : VII, Issue : IV, April - 2018

COMPARITIVE STUDY OF DEXMEDETOMIDINE AND CLONIDINE USED AS ADJUVANTS IN CAUDAL ANAESTHESIA FOR POST OPERATIVE ANALGESIA IN PAEDIATRIC PATIENTS

Ankit Singh, Neelesh Nema

Abstract :

Background: Inadequate treatment of post-operative pain adversely effects physiology, psychology and social interactions in children. Effective pain relief has a positive outcome on surgical stress response, post-operative recovery, early ambulation and psychological and emotional state of paediatric patients in early post-operative period. Dexmedetomidine, an alpha2 receptor agonist, helps to prolong effective analgesia by acting on the pontine locus ceruleus. Clonidine anotherα2 agonist provides a substantial antinociceptiveeffect by acting on the dorsal horn of spinal cord and ain stem nucleiimplicated in pain. Both of these drugsserve as a promising adjunct in caudal block to provide post-operative analgesia.

AIM: The study was undertaken to compare dexmedetomidine and clonidine as an adjuvantalong with Bupivacaine in caudal block with the following aims:

1. Primary objectives: 1) Post-operative analgesia, 2) Intra-operative and post-operative haemodynamic parameters, & 3) Intra-operative and post-operative sedation.

2. Secondary objectives:To evaluate adverse effects and complications, if any.

Material and Method: It was a randomized, prospective, double blinded, comparative hospital based study at Department of Anaesthesiology, Gandhi Medical College, Bhopal. 60 ASA Grade I-II patients, 6 months-6 years of either sex, scheduled for infra-umbilical surgeries were randomly allocated into two groups:

Group 1: received 1 microgram/kg clonidine and

Group 2: received 1 microgram/kg dexmedetomidine,

Added to 0.5% Bupivacaine plain (3mg/kg body wt.) and diluted with normal saline upto total body weight of child through caudal epidural.

i) Postoperative analgesia by FLACC score,

ii) Sedation by Ramsay Sedation Score,

iii) Hemodynamic variables were recorded for 12 hours.

Results: Although there was not much significant difference between the haemodynamic parameters in both the groups,the duration of analgesia was significantly higher in the patients belonging to the Group 2. Likewise, the average numbers of rescue analgesic doses received by Group 1 patients were more compared to patients in Group 2.

Conclusion: From our study we conclude that Dexmedetomidine 1�g/kg is significantly superior to clonidine 1�g/kg in caudal block for causing sedation and in prolonging the duration of analgesia.