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PEDIATRIC ANESTHESIA

Caudal Clonidine Prolongs Analgesia from Caudal S(+)-Ketamine in Children

Department of Anesthesia and Intensive Care Medicine, University of Vienna, Austria

Address correspondence and reprint requests to Peter Marhofer, MD, Department of Anesthesia and Intensive Care Medicine, University of Vienna, School of Medicine, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to peter.marhofer{at}univie.ac.at

We performed a prospective randomized double-blinded study to test preservative-free S(+)-ketamine alone or in combination with clonidine for intra- and postoperative caudal blockade in pediatric surgery over a 24-h period. Fifty-three children (1–72 mo) scheduled for inguinal hernia repair were caudally injected with either S(+)-ketamine 1 mg/kg alone (Group K) or with additional clonidine (Group C1 = 1 µg/kg; Group C2 = 2 µg/kg) during sevoflurane anesthesia via a laryngeal mask. Intraoperative monitoring included heart rate, blood pressure, and pulse oximetry; postoperative monitoring included a pain discomfort scale and a sedation score. No additional analgesic drugs were required during surgery. The mean duration of postoperative analgesia was 13.3 ± 9.2 h in Group K, 22.7 ± 3.5 h in Group C1, and 21.8 ± 5.2 h in Group C2 (P < 0.0001, Group K versus other groups). Groups C1 and C2 received significantly fewer analgesics in the postoperative period than Group K (15% and 18% vs 63%; P < 0.01). The three groups had similar postoperative sedation scores. We conclude that the combination of S(+)-ketamine 1 mg/kg with clonidine 1 or 2 µg/kg for caudal blockade in children provides excellent analgesia without side effects over a 24-h period.

IMPLICATIONS: Caudally administered preservative-free S(+)-ketamine combined with 1 or 2 µg/kg clonidine provides excellent perioperative analgesia in children and has minimal side effects.

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