The efficacy of ropivacaine-fentanyl versus ropivacaine-clonidine for pre-emptive caudal anesthesia in children

Objective: Caudal block has gained much popularity in the past few decades to provide analgesia in pediatric population. Although local anesthetic agents remain the mainstay for caudal blocks, addition of additives to the solution improves quality and duration of analgesia and reduces the toxicity by allowing lower concentrations of the local anesthetic agents. In this regard opioids have been studied extensively, but there is not much comparative research about caudal clonidine. The aim of our current study was to compare the caudal block characteristics of ropivacaine 0.25% with clonidine 1 mu g/kg versus ropivacaine 0.25% with fentanyl 1 mu g/kg in pediatric patients. Methodology: A total of 60 ASA 1 children of either gender, age from 2 to 10 years, weighing 10 to 30 kg, scheduled for lower abdominal or limb surgery, were enrolled for this study. Children were randomly allocated into 2 equal groups. Group RF received 1 ml/kg of ropivacaine 0.25% plus fentanyl 1 mu g/kg via caudal route. Group RC received 1 ml/kg of ropivacaine 0.25% plus clonidine 1 mu g/kg via same route. All children were administered general anesthesia followed by caudal block for postoperative analgesia. Duration of analgesia, sedation score and any side effects were noted. Calculation of sample size was done by using power analysis. The non-parametric data comparison was done by Student's t-test. Results: Duration of analgesia was significantly prolonged in RC group. Dose requirement for rescue analgesia was significantly lesser in group RC. There was no significant difference between both groups for hemodynamic response after caudal block. The incidence of side effects were not significant. Conclusion: In conclusion clonidine and fentanyl, both improve the quality of analgesia when used with ropivacaine in caudal block in pediatric patients, but the quality of analgesia and duration with clonidine plus ropivacaine is superior to fentanyl plus ropivacaine.