Turkish Journal of Anaesthesiology & Reanimation
SYSTEMATİC REVİEW

Clonidine and Morphine as Adjuvants for Caudal Anaesthesia in Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

1.

Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India

2.

Department of Trauma and Emergency (Anaesthesia) All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India

3.

Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India

4.

Department of Otorhinolaryngology, All India Institute of Medical Sciences (AIIMS), Rajasthan, Jodhpur, India

5.

Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Rajasthan, Jodhpur, India

6.

Department of Biostatistics, (South Asian Cochrane Centre), Christian Medical College Vellore, Tamil Nadu, India

7.

Department of Plastic Surgery, All India Institute of Medical Sciences (AIIMS), Rajasthan, Jodhpur, India

8.

Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rajasthan, Jodhpur, India

Turk J Anaesthesiol Reanim 2020; 48: 265-272
DOI: 10.5152/TJAR.2020.29863
Read: 61 Downloads: 43 Published: 02 March 2020

Objective: The aim of this systematic review and meta-analysis is to compare the outcomes of morphine vs. clonidine use as adjuvants in caudal anaesthesia. We are specifically focused on analgesic and side effect profiles.

Methods: We searched databases and trial registration sites and include here randomised controlled trials that compare the analgesic effects of caudal clonidine vs. morphine as adjuvants on postoperative pain. The risk ratio for evaluating pain scores, the need for rescue analgesia and all adverse effects were assessed. The i2 statistic was used to assess heterogeneity. We also assessed risk of bias with Cochrane’s Collaboration tool. The quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results: Four randomised controlled trials (including 166 patients) that evaluated the use of clonidine vs. morphine as adjuvants in caudal block were included in this systematic review and meta-analysis. The pooled estimate for postoperative analgesia revealed no statistically significant differences between the clonidine group compared to morphine group (MD=2.90; 95% CI 4.05 to 9.85; i2 93%). Significantly less postoperative nausea and vomiting were reported among the patients that received clonidine vs. those that were treated with morphine (RR 0.57, 95% CI −0.36 to −0.90, i2 26%). There were no statistically significant differences between the two groups in assessments that included urinary retention, pain scores or need for rescue analgesia at 24 hours.

Conclusion: Clonidine is just as effective as morphine when used an adjuvant to local anaesthetic for caudal block, and has a more desirable side effect profile, particularly with respect to postoperative nausea and vomiting.

Cite this article as: Goyal S, Sharma A, Goswami D, Kothari N, Goyal A, Vyas V, et al. Clonidine and Morphine as Adjuvants for Caudal Anaesthesia in Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Turk J Anaesthesiol Reanim 2020; 48(4): 265-72.

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