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G Ivani, De Negri P, Conio M, Amati M, Roero S, Giannone S, L'nnqvist A. Acta Anaesthesilogica Scandinavica 2000: 44: 446-449.

(Acta Anaesthesilogica Scandinavica is now available full text online at the www.munksgaard.dk/ website free of charge.)

Review: This study prospectively evaluated caudal ropivicaine block with and without clonidine. Forty ASA 1 subjects age 1-7 for elective sub-umbilical surgeries (circumcision, hernia repair, orchiopexy, hydrocoelectomy) were randomized into one of two groups. Both groups underwent a standardized anesthetic and received a caudal block with either ropivicaine 0.2% 1ml/kg without clonidine or ropivicaine 0.1% 1ml/kg with clonidine 2mcg/kg. No other analgesic supplement was given intraoperatively. A blinded observer evaluated time to block onset, duration of analgesia using a modified objective pain score, the time to first analgesic request and sedation.

Ninety percent of the children in the ropivicaine clonidine group vs. 55% of children in the ropivicaine only group required no analgesic rescue in 24 hours (p<0.05). Quality of block, duration block and sedation were not different between groups. No motor impairment was seen in any of the subjects.

Comments: This study was well done overall. It would have been even more convincing if similar concentrations of ropivicaine were evaluated in both groups. A much larger study would need to be done to fully substantiate the claim that adding clonidine and decreasing local concentration is a "safer" alternative. However, this study supports a growing (and promising) body of work demonstrating the efficacy of clonidine in supplementing regional anesthesia in pediatric patients.

Reviewed by: Jeffrey Galinkin, MD
Children's Hospital of Philadelphia