Epidural infusion of clonidine or clonidine plus ropivacaine for postoperative analgesia in children undergoing major abdominal surgery.

STUDY OBJECTIVE

To investigate the analgesic efficacy and safety of epidural infusion of clonidine in children undergoing major abdominal surgery.

DESIGN

Randomized open-label study.

SETTING

Postoperative anesthetic unit and pediatric ward of a metropolitan hospital.

PATIENTS

Forty children aged 0 to 3 years undergoing major abdominal surgery.

INTERVENTIONS

Children were randomly allocated to receive a 24-hour epidural infusion of clonidine 1 microg.mL(-1) at rate of 0.2 mL.kg -1.h -1 preceded by a bolus of 2 microg.kg -1 (CLON group) or a mixture of clonidine 1 microg.mL -1 and ropivacaine 0.1% at rate of 0.2 mL.kg -1.h -1. Both groups received intravenous (IV) ketoprofen 2 mg.kg -1 every 8 hours. Breakthrough pain was treated with IV tramadol 1 mg.kg(-1).

MEASUREMENTS

Tramadol requirement, sedation and respiratory and hemodynamic changes were measured.

MAIN RESULTS

Approximately 77% and 59.3% of the CLON and CLON+ROPIV groups, respectively, required no tramadol or only one dose over a 24-hour period. Except for those patients who exhibited frequent coughing during the night (4 and 5 patients in the CLON and CLON+ROPIV groups, respectively), no study patients required an analgesic and all had good sleep quality during the first night. Sedation and decreased systolic blood pressure were observed after the clonidine bolus was given.

CONCLUSION

For children undergoing major abdominal surgery, the addition of epidural infusion of clonidine or clonidine plus ropivacaine to IV ketoprofen provided good analgesia quality for postoperative rest pain.