1. Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery.
- Author
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Chalkiadis, George A, Sommerfield, David, Low, Janette, Orsini, Francesca, Dowden, Stephanie J, Tay, Michelle, Penrose, Sueann, Pirpiris, Marinis, and Graham, H Kerr
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DRUG side effects , *CEREBRAL palsy treatment , *PEOPLE with cerebral palsy , *BUPIVACAINE , *CLONIDINE , *FENTANYL , *CHILDREN'S health , *ANALGESICS , *CEREBRAL palsy , *COMBINATION drug therapy , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *HEALTH outcome assessment , *POSTOPERATIVE pain , *RESEARCH , *EVALUATION research , *RANDOMIZED controlled trials , *EPIDURAL injections , *PHARMACODYNAMICS - Abstract
Aim: To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery.Method: Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]).Results: There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001).Interpretation: Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile. [ABSTRACT FROM AUTHOR]- Published
- 2016
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