ABSTRACT
Background: Caudal analgesia with bupivacaine and several adjuvants is a very popular in pediatric anesthesia for providing intra- and post-operative analgesia. Methods: This randomized comparative prospective study of total 60 patients of either sex, of ASA Grade I or Grade II, aged between 01 and 12 years, undergoing elective lower abdominal or perineal surgeries were enrolled after written and informed consent. 60 patients undergoing general anesthesia with laryngoscopy and endotracheal intubation followed by caudal anesthesia for post-operative pain relief were randomly allocated into two groups of 30 patients each, Group B received caudal analgesia with 0.25% plain bupivacaine 0.75 ml/kg and Group C received caudal analgesia with 0.25% bupivacaine 0.75 ml/kg with clonidine 1.5 μg/kg after induction of anesthesia but before starting surgery. Intraoperatively heart rate (HR), systolic blood pressure (SBP), and diastolic BP (DBP) were monitored while in post-operative period we monitored following-objective pain score, sedation score, HR, SBP and DBP and any side effects like post-operative nausea and vomiting, respiratory depression in both the groups. The final results of the study were tabulated and analyzed for significance using standard statistical techniques (2 independent sample t-tests). Sedation score was analyzed by using Mann–Whitney test. Results: The objective pain score was significantly lower, and sedation score was significantly higher in bupivacaine with clonidine group. The HR, SBP, and DBP were significantly on the lower side with bupivacaine with clonidine group when compared to plain bupivacaine group, but bradycardia was not statistically significant. Hemodynamic stability and post-operative pain-free period in bupivacaine with clonidine group was more than plain bupivacaine group which was beneficial in surgeries like hypospadias repair. Conclusion: Single shot caudal epidural with the addition of clonidine to bupivacaine is efficient in prolonging the duration of analgesia of plain bupivacaine with minimal or no side effect.
ABSTRACT
Background: Buprenorphine a relatively new, potent, opioid analgesic used for post-operative analgesia and appears to be a longer lasting and has minimal side effects. Methods: Randomized comparative prospective study of 75 patients of American society of anesthesiologist physical Status grade I and II, aged between 25 and 45 years, of both sexes and requiring general anesthesia particularly for upper abdominal surgery, received buprenorphine by different routes. After surgery, when patients had Aldrete recovery score around 9-10 patients received buprenorphine 300 mcg by various routes of administration as follow: Epidural, intramuscular, intravenous slow bolus over 10 min, continuous infusion over 12 h and sublingual tablets. Patients were studied for 48 h postoperatively. The observation was made half an hourly for 2 h and then hourly. Data collected, tables formulated as per meaning full duration of action observed and as per need of simplicity for analysis. Respiration, pulse rates and blood pressure were monitored. Assessment of pain was carried out with numeric rating scale. Results: Meaning full duration of analgesia by different routes were as follows, epidural: 30-35 h in 53.33% of group population, intramuscular: 6-8 h in 86.67% of group population, intravenous bolus: 5-6 h in 73.33% of group population, intravenous infusion: 16-20 h in 60% of group population and sublingual: 5-6 h in 66.66% of group population. Side effects observed due to buprenorphine considering whole population as study sample were urinary retension in three patients (4%), Nausea in fi ve patients (6.67%), vomiting in two patients (2.66%). No cardiorespiratory depression was observed in any of the patient and route of administration technique. Conclusion: Buprenorphine produces a longer duration of meaning full analgesia by all techniques and where the epidural route is best.