Intrathecal Bupivacaine Vs. Bupivacaine And Clonidine In Paediatrics Age Group: A Comparative Evaluation.

摘要

The study was done to compare the efficacy, duration, quality and side effects of intrathecal bupivacaine alone and bupivacaine plus clonidine. A prospective randomised double blind study was carried out in 60 ASA-1 paediatrics patients undergoing surgeries below T8 dermatome up to 2 hrs duration. Patients were randomly allocated in two groups. Group-A received bupivacaine .5% heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15 kg) and Group-B received bupivacaine 0.5%heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15kg) and preservative free clonidine (1 mcg/kg), comprising 30 patients each. Time of onset of sensory block, maximum level of sensory block, duration of sensory block, duration of post-op analgesia and side effects were observed. Data obtained was subjected to statistical computation and analysed using computer programme statistical package for social science (SPSS)ver-16.0 and tests performed were unpaired student-t test, nonparametric mann-whitney two samples test and Chi square test. Value of p<0.05 was considered significant and p<0.0000001 highly significant. Awake sedation score with clonidine was better than bupivacaine alone. The side effect profile: only one patient of Group-A had bradycardia and in Group-B two patients had bradycardia and two patients had hypotension. No patients in any group had nausea vomitting, post dural puncture headache, urinary retention or high spinal. Adding clonidine is providing early onset of sensory block, adequate sedation and prolonged postoperative analgesia. Introduction Pain is a major concern of human kind since our beginning and object of ubiquitous efforts to understand and to control it. Pediatric pain management is challenging and one of the frontiers of modern anesthesia. The first report on paediatric spinal anesthesia was published by AUGUST BIER in 1899, when the technique was performed with cocaine in an 11 year old boy for ischium abscess drainage.Spinal anaesthesia is advantageous in that it uses small dose of anesthetic, is easy to perform and offers a rapid onset, reliable surgical analgesia and good muscle relaxation. Advantages sometime offset by relatively short duration of action and complaints of post operative pain when it wears off. Spinal anaesthesia with hyperbaric bupivacaine hydrochloride is popular for longer procedure due to its prolonged duration but there is need to intensify and increased duration of sensory blocked without increasing the intensity and duration of motor blocked and thus prolong the duration of post operative analgesia.Various studies have shown that 1mcg/kg clonidine provides a significant improvement in spinal anaesthesia quality, duration and reduces the need of post-operative analgesic requirement without a significant side effects[1,2,3,4,5,10,11]. There is adequate evidence that α-2 adrenergic agonist clonidine given intrathecally produces anti nociceptive effects without any neurotoxicity and useful in the treatment of somatic pain[1,2,3,4]. However, unlike spinal opioides clonidine does not produce pruritis and respiratory depression. The rationale behind intrathecal administration of clonidine is to achieve a high drug concentration in the vicinity of α-2 adrenoreceptors in spinal cord by blocking pain conduction of C and A-delta fibres. It increases potassium conductance in isolated neurons in vitro and intensifies conduction block of local anaesthetic[7] . Aδ fibres are myelinated afferent sensory nerve fibres which conduct pain, cold temperature and touch sensation, and C fibres are nonmyelinated postganglionic sympathetic fibres which conduct pain, warm temperature and touch sensation.[8] Clonidine is now an acceptable adjuvant to local anaesthetic for epidural route nevertheless clinical trial provide evidence that less clonidine is needed intrathecaly than epidural to produce same analgesic effect with fewer side effects.In the present study we tried to find out effectiveness of 1mcg/kg intrathecal clonidine added to h