Intrathecal bupivacaine versus bupivacaine and clonidine in pediatrics: a double-blind controlled study

Background: Spinal anesthesia is establishing a place in pediatric daycare anesthesia as a possible substitute for general anesthesia in children undergoing infraumbilical abdominal or lower extremity surgeries. Clonidine intensifies the effect of bupivacaine when given intrathecally as an adjuvant. Methods and Objective of study: This is a prospective randomized double-blind study carried out in 60 ASA physical status 1 and 2 (3-13 years) pediatric patients scheduled for infraumbilical abdominal or lower extremity surgeries. Participants were randomly allocated to two groups. Group B received hyperbaric bupivacaine 0.5% alone (0.4 mg/kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg), and group BC received hyperbaric bupivacaine 0.5% (0.4 mg/kg for wt. 5-15 kg or 0.3 mg/kg for wt. > 15 kg) and preservative-free clonidine (1 mu g/kg), comprising 30 patients each. The primary outcome was the measurement of the time of onset of sensory block, the maximum level of sensory block, duration of sensory block, and duration of post-op analgesia. Results: The mean onset of sensory block was 3.04 +/- 1.5 min in group BC vs. 5.01 +/- 0.30 in group B p = 0.0001. The mean onset of motor block was also earlier in group BC 3.81 +/- 0.38 min vs. 6.47 +/- 4.66 min in group B p = 0.0028. The mean duration of analgesia was 391.33 +/- 33 min in group BC vs. 194.5 +/- 28 min in group B with a p-value of 0.0001. None of the patients belonging to either group demonstrated a segmental level higher than T-5. Conclusions: We infer that clonidine is a good adjuvant to bupivacaine in spinal anesthesia in pediatric patients as far as comfort is concerned. It decreases the time taken for onset, has a longer duration of postoperative analgesia, and has a better quality of sedation with no added side effects as compared to bupivacaine alone, in pediatric patients undergoing surgeries below T-8 dermatome.