An evaluation of intrathecal bupivacaine combined with intrathecal or intravenous clonidine in children undergoing orthopedic surgery: a randomized double-blinded study

Abstract

Background: Propofol is a popular agent for providing intraoperative sedation in pediatric population during lumbar puncture and spinal anesthesia. Adjuvant-like clonidine is used increasingly in pediatric anesthesia to provide postoperative analgesia with a local anesthetic agent. The aim of this study was to assess the effects of intrathecal and intravenous clonidine on postoperative analgesia/sedation and intraoperative requirements of propofol after intrathecal bupivacaine for orthopedic surgery in children.

Methods: Fifty-nine ASA I and II children aged 6-8 year undergoing orthopedic surgery were randomized to receive intrathecal 0.5% bupivacaine 0.2-0.4 mg·kg(-1) and intravenous 2 ml saline (Group B), intrathecal 0.5% bupivacaine 0.2-0.4 mg·kg(-1) plus 1 μg·kg(-1) clonidine and intravenous 2 ml saline (Group BCit), and 0.5% bupivacaine 0.2-0.4 mg·kg(-1) and intravenous 1 μg·kg(-1) clonidine in 2 ml of saline (Group BCiv). Intraoperative sedation was maintained with 20-50 μg·kg(-1)·min(-1) of propofol infusion. The requirements of propofol, time to first rescue analgesia, and postoperative pain or sedation scores were assessed. The duration of motor and sensory blocks and perioperative adverse events were determined.

Results: Clonidine significantly prolonged the time to first rescue analgesia and reduced the requirements of propofol sedation whether administered intravenously or intrathecally. The mean Children and Infants Postoperative Pain Scale scores of children were significantly lower in groups BCit and BCiv than in group B. Postoperative sedation scores were higher in groups BCit and BCiv than in group B. Intrathecal clonidine significantly prolonged the time to regression of the sensory block and recovery of motor block. There were no significant differences among the three groups regarding the incidence of perioperative adverse events.

Conclusion: Intrathecal or intravenous clonidine similarly provided better postoperative analgesia and sedation and reduced the requirements of propofol. Only intrathecal clonidine prolonged the duration of sensory and motor blocks.