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Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery.
- Source :
-
Developmental Medicine & Child Neurology . Apr2016, Vol. 58 Issue 4, p402-408. 7p. - Publication Year :
- 2016
-
Abstract
- <bold>Aim: </bold>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.<bold>Method: </bold>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]).<bold>Results: </bold>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).<bold>Interpretation: </bold>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]
- Subjects :
- *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
Subjects
Details
- Language :
- English
- ISSN :
- 00121622
- Volume :
- 58
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Developmental Medicine & Child Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 113876152
- Full Text :
- https://doi.org/10.1111/dmcn.12930