Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery
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...
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| Veröffentlicht in: | Developmental medicine and child neurology 2016-04, Vol.58 (4), p.402-408 |
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| creator | Chalkiadis, George A Sommerfield, David Low, Janette Orsini, Francesca Dowden, Stephanie J Tay, Michelle Penrose, Sueann Pirpiris, Marinis Graham, H Kerr |
| description | 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 |
| doi_str_mv | 10.1111/dmcn.12930 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1775169465</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1775169465</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4350-19fef3a03e3aeafa3cb1a4b347051767d69be1562a15a4b40ce08f775f43fa4b3</originalsourceid><addsrcrecordid>eNp9kUFu1TAQhi0Eoq-FDQdAXiKkFDt2nJcleoWCVGAD62jijF-NHDvYyauy4wgcg3NxEhxSWDIbz4w_fZb1E_KMs0ue61U_aH_Jy0awB2THpWqKfS2bh2THGC8LrsryjJyn9JUxJlQlH5OzUknG9ny_Iz8PYRgh2hQ8DYa6eeggUhxtP0dwtJtHewIN1iO9s9MtNegn8IujIVLtgrf9emXyNIY0hREjTPaEFDy4IyYL1Hqqb63rI_pNoTFit8pHcGmhYCaMNFl_dPjr-w885RfoMLvJutw7muZ4xLg8IY9M5vHp_XlBvrx98_nwrrj5dP3-8Pqm0FJUrOCNQSOACRSAYEDojoPshKxZxWtV96rpkFeqBF7lvWQa2d7UdWWkMCt4QV5s3jGGbzOmqR1s0ugceAxzanlmuWqkqjL6ckN1DClFNO0Y7QBxaTlr12TaNZn2TzIZfn7vnbsB-3_o3ygywDfgLn98-Y-qvfpw-LhJfwOLzJ9S</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1775169465</pqid></control><display><type>article</type><title>Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>Wiley Online Library (Open Access Collection)</source><creator>Chalkiadis, George A ; Sommerfield, David ; Low, Janette ; Orsini, Francesca ; Dowden, Stephanie J ; Tay, Michelle ; Penrose, Sueann ; Pirpiris, Marinis ; Graham, H Kerr</creator><creatorcontrib>Chalkiadis, George A ; Sommerfield, David ; Low, Janette ; Orsini, Francesca ; Dowden, Stephanie J ; Tay, Michelle ; Penrose, Sueann ; Pirpiris, Marinis ; Graham, H Kerr</creatorcontrib><description>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.
What this paper adds
Epidural bupivacaine with fentanyl or clonidine provides effective analgesia after single event multilevel surgery.
Adding clonidine results in lower heart rate and blood pressure.
Adding fentanyl results in more vomiting and oxygen desaturation.</description><identifier>ISSN: 0012-1622</identifier><identifier>EISSN: 1469-8749</identifier><identifier>DOI: 10.1111/dmcn.12930</identifier><identifier>PMID: 26400818</identifier><language>eng</language><publisher>England</publisher><subject>Analgesics - administration & dosage ; Analgesics - pharmacology ; Bupivacaine - administration & dosage ; Bupivacaine - pharmacology ; Cerebral Palsy ; Child ; Clonidine - administration & dosage ; Clonidine - pharmacology ; Drug Therapy, Combination ; Female ; Fentanyl - administration & dosage ; Fentanyl - pharmacology ; Humans ; Injections, Epidural ; Male ; Outcome Assessment (Health Care) - methods ; Pain, Postoperative - drug therapy</subject><ispartof>Developmental medicine and child neurology, 2016-04, Vol.58 (4), p.402-408</ispartof><rights>2015 Mac Keith Press</rights><rights>2015 Mac Keith Press.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4350-19fef3a03e3aeafa3cb1a4b347051767d69be1562a15a4b40ce08f775f43fa4b3</citedby><cites>FETCH-LOGICAL-c4350-19fef3a03e3aeafa3cb1a4b347051767d69be1562a15a4b40ce08f775f43fa4b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdmcn.12930$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdmcn.12930$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,1435,27931,27932,45581,45582,46416,46840</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26400818$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chalkiadis, George A</creatorcontrib><creatorcontrib>Sommerfield, David</creatorcontrib><creatorcontrib>Low, Janette</creatorcontrib><creatorcontrib>Orsini, Francesca</creatorcontrib><creatorcontrib>Dowden, Stephanie J</creatorcontrib><creatorcontrib>Tay, Michelle</creatorcontrib><creatorcontrib>Penrose, Sueann</creatorcontrib><creatorcontrib>Pirpiris, Marinis</creatorcontrib><creatorcontrib>Graham, H Kerr</creatorcontrib><title>Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery</title><title>Developmental medicine and child neurology</title><addtitle>Dev Med Child Neurol</addtitle><description>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.
What this paper adds
Epidural bupivacaine with fentanyl or clonidine provides effective analgesia after single event multilevel surgery.
Adding clonidine results in lower heart rate and blood pressure.
Adding fentanyl results in more vomiting and oxygen desaturation.</description><subject>Analgesics - administration & dosage</subject><subject>Analgesics - pharmacology</subject><subject>Bupivacaine - administration & dosage</subject><subject>Bupivacaine - pharmacology</subject><subject>Cerebral Palsy</subject><subject>Child</subject><subject>Clonidine - administration & dosage</subject><subject>Clonidine - pharmacology</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Fentanyl - administration & dosage</subject><subject>Fentanyl - pharmacology</subject><subject>Humans</subject><subject>Injections, Epidural</subject><subject>Male</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Pain, Postoperative - drug therapy</subject><issn>0012-1622</issn><issn>1469-8749</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFu1TAQhi0Eoq-FDQdAXiKkFDt2nJcleoWCVGAD62jijF-NHDvYyauy4wgcg3NxEhxSWDIbz4w_fZb1E_KMs0ue61U_aH_Jy0awB2THpWqKfS2bh2THGC8LrsryjJyn9JUxJlQlH5OzUknG9ny_Iz8PYRgh2hQ8DYa6eeggUhxtP0dwtJtHewIN1iO9s9MtNegn8IujIVLtgrf9emXyNIY0hREjTPaEFDy4IyYL1Hqqb63rI_pNoTFit8pHcGmhYCaMNFl_dPjr-w885RfoMLvJutw7muZ4xLg8IY9M5vHp_XlBvrx98_nwrrj5dP3-8Pqm0FJUrOCNQSOACRSAYEDojoPshKxZxWtV96rpkFeqBF7lvWQa2d7UdWWkMCt4QV5s3jGGbzOmqR1s0ugceAxzanlmuWqkqjL6ckN1DClFNO0Y7QBxaTlr12TaNZn2TzIZfn7vnbsB-3_o3ygywDfgLn98-Y-qvfpw-LhJfwOLzJ9S</recordid><startdate>201604</startdate><enddate>201604</enddate><creator>Chalkiadis, George A</creator><creator>Sommerfield, David</creator><creator>Low, Janette</creator><creator>Orsini, Francesca</creator><creator>Dowden, Stephanie J</creator><creator>Tay, Michelle</creator><creator>Penrose, Sueann</creator><creator>Pirpiris, Marinis</creator><creator>Graham, H Kerr</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201604</creationdate><title>Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery</title><author>Chalkiadis, George A ; Sommerfield, David ; Low, Janette ; Orsini, Francesca ; Dowden, Stephanie J ; Tay, Michelle ; Penrose, Sueann ; Pirpiris, Marinis ; Graham, H Kerr</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4350-19fef3a03e3aeafa3cb1a4b347051767d69be1562a15a4b40ce08f775f43fa4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Analgesics - administration & dosage</topic><topic>Analgesics - pharmacology</topic><topic>Bupivacaine - administration & dosage</topic><topic>Bupivacaine - pharmacology</topic><topic>Cerebral Palsy</topic><topic>Child</topic><topic>Clonidine - administration & dosage</topic><topic>Clonidine - pharmacology</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Fentanyl - administration & dosage</topic><topic>Fentanyl - pharmacology</topic><topic>Humans</topic><topic>Injections, Epidural</topic><topic>Male</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Pain, Postoperative - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chalkiadis, George A</creatorcontrib><creatorcontrib>Sommerfield, David</creatorcontrib><creatorcontrib>Low, Janette</creatorcontrib><creatorcontrib>Orsini, Francesca</creatorcontrib><creatorcontrib>Dowden, Stephanie J</creatorcontrib><creatorcontrib>Tay, Michelle</creatorcontrib><creatorcontrib>Penrose, Sueann</creatorcontrib><creatorcontrib>Pirpiris, Marinis</creatorcontrib><creatorcontrib>Graham, H Kerr</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Developmental medicine and child neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chalkiadis, George A</au><au>Sommerfield, David</au><au>Low, Janette</au><au>Orsini, Francesca</au><au>Dowden, Stephanie J</au><au>Tay, Michelle</au><au>Penrose, Sueann</au><au>Pirpiris, Marinis</au><au>Graham, H Kerr</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery</atitle><jtitle>Developmental medicine and child neurology</jtitle><addtitle>Dev Med Child Neurol</addtitle><date>2016-04</date><risdate>2016</risdate><volume>58</volume><issue>4</issue><spage>402</spage><epage>408</epage><pages>402-408</pages><issn>0012-1622</issn><eissn>1469-8749</eissn><abstract>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.
What this paper adds
Epidural bupivacaine with fentanyl or clonidine provides effective analgesia after single event multilevel surgery.
Adding clonidine results in lower heart rate and blood pressure.
Adding fentanyl results in more vomiting and oxygen desaturation.</abstract><cop>England</cop><pmid>26400818</pmid><doi>10.1111/dmcn.12930</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Developmental medicine and child neurology, 2016-04, Vol.58 (4), p.402-408 |
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| language | eng |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; Wiley Online Library (Open Access Collection) |
| subjects | Analgesics - administration & dosage Analgesics - pharmacology Bupivacaine - administration & dosage Bupivacaine - pharmacology Cerebral Palsy Child Clonidine - administration & dosage Clonidine - pharmacology Drug Therapy, Combination Female Fentanyl - administration & dosage Fentanyl - pharmacology Humans Injections, Epidural Male Outcome Assessment (Health Care) - methods Pain, Postoperative - drug therapy |
| title | Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery |
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