The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

Year 2023, Volume: 10 Issue: 1, 34 - 41, 10.04.2023

Eylem Yaşar Çiğdem Tütüncü Güner Kaya

https://doi.org/10.47572/muskutd.1088900

Abstract

Ineffective post-operative pain management in children may be associated with chronic pain. 98 pediatric patients aged 6 months to 12 years who underwent caudal levobupivacaine for hypospadias surgery were evaluated retrospectively. The patients who received additional intravenous clonidine were added in group 1; the patients who received additional intravenous morphine were added in group 2, patients who received additional caudal clonidine was added in group 3, and patients who received additional caudal morphine was added in group 4. CHEOPS score was assessed 1, 6, 12 and 24 hours after the operation and patients with score 6 or higher were determined. At the 1st hour, there were 8 cases in the intravenous morphine group (40%), 5cases in the intravenous clonidine group (25%), and 3 cases in the caudal morphine group (15%). At the 12th hour, there were 5 cases in the intravenous morphine group (25%), 10 cases in the intravenous clonidine group (50%), and 4 cases in the caudal morphine group (20%). At the 24th hour, there were 10 cases in the intravenous morphine group (50%), 10 cases in the intravenous clonidine group (50%), 9 cases in the caudal morphine group (45%) and 2 cases in the caudal clonidine group (10%) (p<0.05). There was no difference between the groups in terms of sedation scores at all hours (p>0.05). The lowest pain scores at the 1st, 12th, and 24th hours were recorded in the caudal clonidine group. It had the lowest pain scores at 6 hours. By these methods, in favor of the clonidine group, we agreed that the analgesia lasts for approximately 12 hours postoperatively, so the postoperative stress that the children and their families have can be minimized.

Keywords

Intravenous Clonidine, Caudal Analgesia, Caudal Clonidine, Pediatric Postoperative Analgesia

Çocuklarda Levobupivakain ile Yapılan Kaudal Bloğa Kaudal veya İntravenöz Morfin ve Klonidin Eklenmesinin Sonuçları; Geriye Dönük Bir Çalışma

Abstract

Çocuklarda Postoperatif ağrı tedavisinin etkin şeklide yapılamaması kronik ağrı ile ilişkili olabilmektedir. Yaşları 6 ay ile 12 arasında değişen, hipospadias cerrahisi için kaudal levobupivakain uygulanan 98 pediatrik hasta retrospektif olarak değerlendirildi. Kaudal levopubivakaine intravenöz klonidin eklenmiş hastalar grup 1; intravenöz morfin eklenmiş hastalar grup 2, kaudal klonidin eklenmiş hastalar grup 3 ve kaudal morfin eklenen hastalar grup 4 olarak adlandırıldı. İntravenöz morfin grubunda 8 olgu (%40), intravenöz klonidin grubunda 5 olgu (%25) ve kaudal morfin grubunda 3 olgu (%15)’da 1. saatte CHEOPS ağrı skoru 6 ve üzerinde idi. Bununla birlikte kaudal klonidin grubundaki tüm olguların 1. saat CHEOPS değerleri 6'nın altındaydı (p<0.05). 12. saatte; intravenöz morfin grubunda 5 olguda (%25), intravenöz klonidin grubunda 10 olguda (%50) ve kaudal morfin grubunda (%20) 4 hastada CHEOPS değerleri 6 ve üzerinde idi. 24. saatte ise; intravenöz morfin grubunda 10 olgu (%50), intravenöz klonidin grubunda 10 olgu (%50), kaudal morfin grubunda 9 olgu (%45) ve kaudal klonidin grubunda 2 olguda (%10) CHEOPS değerleri 6 ve üzerinde idi (p<0.05). Sedasyon skorları açısından gruplar arasında tüm saatlerde fark yoktu (p>0.05). En düşük ağrı skorları 1., 12. ve 24. saatlerde kaudal klonidin grubunda kaydedildi. Tüm gruplar değerlendirildiğinde 6 saatte en düşük, en iyi ağrı skorları ile karşılaşıldı. Bizim çalışmamızda klonidin grubu lehine analjezinin postoperatif 12 saat boyunca sürdüğünü, böylece çocukların ve ailelerinin postoperatif streslerinin en aza indirilebileceğini kabul ettik.

Keywords

Intravenöz Klonidin, Kaudal Analjezi, Kaudal Klonidin, Pediatrik Postoperatif Analjezi

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