A comparative study of Fentanyl and Clonidine as additives to plain Bupivacaine in caudal anaesthesia in children for postoperative analgesia in Infraumbilical and Genitourinary Surgeries.

Caudal
anesthesia is a common regional technique in pediatric patients ,in children
caudal anesthesia is typically combined with general anesthesia for
intraoperative supplementation and postoperative analgesia. Children
experience pain in the same way as adults, though they may be unable to
describe the pain ,postoperative analgesia in children is a challenging
hurdle before the anesthesiologist. Good and prolonged postoperative
analgesia not only relieves pain in children but also relieves anxiety in
parents1. Caudal analgesia is an accepted and popular method of
providing intra operative and postoperative analgesia for genitourinary and
inguinal surgeries in children, as it is safe, reliable and easy to administer1.

Bupivacaine is the most commonly used local anesthetic for caudal block but its limitation is short duration of action, about 4-6 hours when administered as a single shot technique. Prolongation of caudal block can be achieved by addition of various additives like epinephrine, ketamine, opioids, clonidine, dexmedetomidine and neostigmine. The addition of adjuncts not only increases the effectiveness of a local anesthetic by prolonging and intensifying the sensory blockade but also causes reduction in dose of local anaesthetic agents use.

Ketamine has potential for neurotoxic effects, if inadvertently injected intrathecally and neostigmine is accompanied by 30% incidence of vomiting. Opioids and local anesthetics administered together have synergistic analgesic effects, but carries the risk of respiratory depression. Because of its rapid onset of action and high lipid solubility, fentanyl is considered to be a suitable opioid for caudal administration. The role of Clonidine as an analgesic administered by caudal route is now well established in children. Co-administration of caudal Clonidine with Bupivacaine has been found to prolong analgesia without significant respiratory depression after epidural administration.

This study is to assess the efficacy and safety of Fentanyl and Clonidine in low doses as an adjuvant to Bupivacaine for postoperative analgesia in pediatric genitourinary and infraumbilical surgeries.