Article

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.
CI - (c) 2015 Mac Keith Press.

Langue : ANGLAIS