Analgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine

Paediatr Anaesth. 2001 Nov;11(6):695-700. doi: 10.1046/j.1460-9592.2001.00748.x.


Background: Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain.

Methods: We compared the effect of clonidine, 1 and 2 microg x kg(-1), added to bupivacaine (1.25 mg x kg(-1)) with that of bupivacaine alone in 75 male children undergoing elective circumcision.

Results: There was a trend towards increasing duration of analgesia with increasing dose of clonidine [group B (bupivacaine) 280.7 (171.6) min, C1 (bupivacaine + clonidine 1 microg x kg(-1)) 327.8 (188.3) min and C2 (bupivacaine + clonidine 2 microg x kg(-1)) 382.0 (200.6) min], although this difference was not statistically significant. Mean time to arousal from anaesthesia was significantly prolonged with clonidine 2 microg kg(-1) (group C2 21.3 (13-36) min, group C1 14.0 (6-25) min and group B 14.4 (2-32) min. Supplementary analgesic requirements and incidence of adverse effects were low, with no differences between the groups.

Conclusions: For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 microg x kg(-1) to low volume (0.5 ml x kg(-1)) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic alpha-Agonists* / administration & dosage
  • Analgesia*
  • Anesthesia, Spinal*
  • Anesthetics, Local*
  • Bupivacaine*
  • Child
  • Child, Preschool
  • Circumcision, Male*
  • Clonidine* / administration & dosage
  • Humans
  • Infant
  • Male
  • Pain Measurement
  • Pain, Postoperative / epidemiology
  • Pain, Postoperative / prevention & control


  • Adrenergic alpha-Agonists
  • Anesthetics, Local
  • Clonidine
  • Bupivacaine