Background: The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. Most\r\nof the studies in adults have demonstrated the positive effects of clonidine on intra- and postoperative analgesia\r\nwhen used as an adjunctive agent or in some cases as a single to regional techniques. In the pediatric population,\r\nthere are only few trials involving clonidine as an adjunct to regional anesthesia, and the analgesic benefits are not\r\ndefinite in this group of patients. The evidence concerning perineural administration of clonidine is so far\r\ninconclusive in children, as different types and volume of local anesthetic agents have been used in these studies.\r\nMoreover, the efficacy of regional anesthesia is largely affected by the operatorâ��s technique, accuracy and severity\r\nof operation.\r\nMethods: The use of clonidine alone or combined with 0.2% ropivacaine for effective analgesia after mild to\r\nmoderate painful foot surgery was assessed in 66 children, after combined sciatic lateral popliteal block (SLPB) plus\r\nfemoral block. The patients were randomly assigned into three groups to receive placebo, clonidine, and clonidine\r\nplus ropivacaine. Time to first analgesic request in the groups was analyzed by using Kaplan-Meier and the logrank\r\ntest (mean time, median time, 95% CI).\r\nResults: In our study, clonidine administered alone in the SLPB seems promising, maintaining intraoperatively the\r\nhemodynamic parameters SAP, DAP, HR to the lower normal values so that no patient needed nalbuphine under\r\n0.6 MAC sevoflurane anesthesia, and postoperatively without analgesic request for a median time of 6 hours. In\r\naddition, clonidine administered as adjuvant enhances ropivacaineâ��s analgesic effect for the first postoperative day\r\nin the majority of children (p = 0.001). Clonidine and clonidine plus ropivacaine groups also didnâ��t demonstrate\r\nPONV, motor blockade, and moreover, the parents of children expressed their satisfaction with the excellent\r\nperioperative management of their children, with satisfaction score 9.74 �± 0.45 and 9.73 �± 0.70 respectively. On the\r\ncontrary all the patients in the control group required rescue nalbuphine in the recovery room, and\r\npostoperatively, along with high incidence of PONV, and the parents of children reported a low satisfaction score\r\n(7.50 �± 0.70).\r\nConclusions: Clonidine appears promising more as an adjuvant in 0.2% ropivacaine and less than alone in the\r\nSLPB plus femoral block in children undergoing mild to moderate painful foot surgery, with no side effects.
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