Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery

50 children with cerebral palsy scheduled for single-event multilevel surgery (SEMLS) were included in this randomized trial. Each patient received general anesthesia and then epidural analgesia with bupivacaine and either clonidine or standard fentanyl , according to randomization. The purpose of this study was to determine if the addition of clonidine to epidural bupivacaine resulted in significantly improved pain relief and control of muscle spasms when compared to fentanyl throughout a 72-hour observational period. Secondary outcomes of interest included various potential side effects, including vomiting, sedation, administration of anti-emetics or paracetamol, and respiratory characteristics. The overall results demonstrated no significant differences in Diazepam use, the rate of muscle spasm, or mean pain scores over the first 72 hours between groups. Patients in the clonidine group had fewer incidences of vomiting, required fewer anti-emetic administations and had fewer combined nursing interventions , while patients in the fentanyl group had significantly increased oxygen desaturation and a decreased respiratory rate.