{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:33:45Z","timestamp":1787762025298,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Adjuvants added to the caudal block prolong the duration of analgesia. In a developing country with economic constraints, the choice of an adjuvant will be the medication with a longer duration of analgesia, a favorable side-effect profile, and the least expensive option. We wished to study the duration of postoperative analgesia afforded by three adjuvants: morphine, clonidine, and dexmedetomidine, at doses wherein minimal or nil adverse effects would be attributed to the adjuvant. The primary objective of the current study is to compare the duration of postoperative analgesia with morphine, clonidine, or dexmedetomidine as adjuvants to 0.2% ropivacaine in a for caudal block, in children undergoing elective abdominal, urogenital, and lower limb surgeries. The secondary objectives are (a) to study the total analgesic requirement during the first 24 hours after surgery and (b) to compare the incidence of complications among the three groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>Sixty-three children aged 1\u20136 years, belonging to American Society of Anesthesia (ASA) physical status I, II, and scheduled to undergo elective infraumbilical surgeries, were enrolled in the study. The children were randomly assigned to one of three groups: Group D received a caudal block with dexmedetomidine 1 \u03bcg\/kg, Group M received morphine 30 \u03bcg\/kg, and Group C received clonidine 1.5 \u03bcg\/kg. All groups also received 0.2% ropivacaine (1\u20131.25 ml\/kg) as part of the caudal block. The duration of analgesia, total analgesic requirements during the first 24 hours after the surgery, and the incidence of complications in the three groups were monitored by a pain nurse who was blinded to the study allocation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The three groups were comparable with respect to age, sex, weight, and duration of surgery. The median time taken for the first rescue analgesic in the dexmedetomidine group was 380 minutes, in the clonidine group was 360 minutes, and in the morphine group was 405 minutes. Though the morphine group had a longer duration of analgesia, it was not statistically significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.843). The total perioperative opioids used and side effects were similar among the three groups. There were no episodes of intraoperative bradycardia noted in Groups D, M, and C. However, one patient in Group D required treatment for bradycardia in the postanesthesia care unit. In terms of intraoperative hypotension, 10 patients (43.5%) in Group D, 5 patients (27.8%) in Group C, and 5 patients (22.7%) in Group M required treatment, but this difference was not statistically significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.299). There was no significant difference observed in the time to awakening after the anesthesia among the three groups. Postoperative nausea and vomiting were noted in five patients (21.7%) in Group D, one patient (5.6%) in Group C, and four patients (18.2%) in Group M (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.382). One patient in Group M had a sedation score of 5 and required 4 hours of supplemental oxygen via face mask in the ward. Additionally, one patient in Group D reported numbness in both feet lasting 12 hours with spontaneous resolution. While a significant number of patients in all three study groups experienced urinary retention, no patient reported pruritus in the ward.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Caudal administration of morphine, dexmedetomidine, and clonidine in children undergoing infraumbilical surgery resulted in an equivalent duration of analgesia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_12_23","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T14:21:26Z","timestamp":1689085286000},"page":"388-394","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries"],"prefix":"10.4103","volume":"40","author":[{"given":"Aparanjit Paul","family":"Pallapati","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riya","family":"Jose","sequence":"additional","affiliation":[{"name":"Department of Acute Surgical Unit, Lyell McEwin Hospital, Elizabeth Vale, South Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beulah","family":"Devadharshini","sequence":"additional","affiliation":[{"name":"Department of Nursing Services, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahasampath","family":"Gowri","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita S.","family":"Joselyn","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7,7]]},"reference":[{"key":"R1-20240830","doi-asserted-by":"crossref","first-page":"170","DOI":"10.5812\/traumamon.3393","article-title":"Addition of clonidine in caudal anesthesia in children increases duration of post-operative analgesia","volume":"16","author":"Lak","year":"2012","journal-title":"Trauma Mon"},{"key":"R2-20240830","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/bja\/aeg064","article-title":"Caudal additives in children\u2014solutions or problems?","volume":"90","author":"de","year":"2003","journal-title":"Br J 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Physician"},{"key":"R12-20240830","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1111\/pan.12686","article-title":"Comparison of caudal bupivacaine alone with bupivacaine plus two doses of dexmedetomidine for postoperative analgesia in pediatric patients undergoing infra-umbilical surgery:A randomized controlled double-blinded study","volume":"25","author":"Al-Zaben","year":"2015","journal-title":"Paediatr Anaesth"},{"key":"R13-20240830","doi-asserted-by":"crossref","first-page":"836","DOI":"10.23736\/S0375-9393.18.12523-5","article-title":"Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children","volume":"84","author":"Trifa","year":"2018","journal-title":"Minerva Anestesiol"},{"key":"R14-20240830","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4103\/jcls.jcls_15_17","article-title":"A randomized double-blinded comparison between dexmedetomidine and clonidine as an adjuvant to caudal ropivacaine in children for below umbilical surgery","volume":"14","author":"Mavuri","year":"2017","journal-title":"J Clin Sci"},{"key":"R15-20240830","doi-asserted-by":"crossref","first-page":"185","DOI":"10.4103\/0970-9185.94839","article-title":"Efficacy of clonidine as an adjuvant to ropivacaine for caudal analgesia in children undergoing subumbilical surgery","volume":"28","author":"Manickam","year":"2012","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R16-20240830","doi-asserted-by":"crossref","first-page":"781","DOI":"10.18203\/2349-2902.isj20200822","article-title":"Study of morphine with ropivacaine and ropivacaine alone for caudal epidural analgesia in children","volume":"7","author":"Sailo","year":"2020","journal-title":"Int Surg J"},{"key":"R17-20240830","doi-asserted-by":"crossref","first-page":"241","DOI":"10.4103\/0970-9185.209739","article-title":"Comparative study of caudal clonidine and midazolam added to bupivacaine during infra-umbilical surgeries in children","volume":"33","author":"Sanwatsarkar","year":"2017","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R18-20240830","doi-asserted-by":"crossref","first-page":"499","DOI":"10.4103\/ija.IJA_712_16","article-title":"Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries:A prospective, randomised, double-blinded clinical study","volume":"61","author":"Gupta","year":"2017","journal-title":"Indian J Anaesth"}],"container-title":["Journal of Anaesthesiology Clinical 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