Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children

Background: Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose–response trial. Methods: A group of 120 children aged <6 years of age received caudal anesthesia with levobupivacaine and 1, 2, or 3 μg·kg^?1 of clonidine. The MLAC was determined according to a Dixon‐Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. Results: The MLAC of caudal levobupivacaine was 0.106%, 0.077%, and 0.035% with 1, 2, and 3 μg·kg^?1 of clonidine, respectively. There were significant dose‐dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 μg·kg^?1 of clonidine group. Conclusions: Clonidine produces a local anesthetic sparing effect with a dose‐dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose‐dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 μg·kg^?1 of clonidine provides the optimum balance between improved analgesia and minimal side effects.