title: Optimum concentration of bupivacaine for combined caudal--general anesthesia in children.
abstract: Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and intraoperative supplementation to general anesthesia for children. To determine the best concentration of bupivacaine for combined general-caudal anesthesia in children, 122 children aged 1-8 yr scheduled for outpatient inguinal herniorrhaphy were randomized to receive, in a double-blind fashion, caudal anesthesia with bupivacaine in one of six concentrations (0.125, 0.15, 0.175, 0.2, 0.225, or 0.25%). After incision, a programmed reduction in inspired halothane resulted, if tolerated by the subject, in an inspired halothane concentration of 0.5% 10 min after incision. End-tidal halothane concentration at hernia sac ligation for subjects receiving 0.175% bupivacaine (0.55 +/- 0.03%) was less than that for subjects receiving 0.15% bupivacaine (0.75 +/- 0.05%; P less than 0.05). Subjects receiving 0.175% bupivacaine also were discharged earlier from the postanesthesia care unit (PACU) (27 +/- 1 min) than were subjects receiving 0.15% bupivacaine (38 +/- 5 min; P = 0.05). Children receiving greater than or equal to 0.2% bupivacaine tended to complain more of leg weakness after surgery; however, the difference did not reach statistical significance (39 of 67 vs. 16 of 47; P = 0.057). The incidence of complaints of leg weakness and paresthesia was positively correlated with bupivacaine concentration (r = 0.706; P = 0.05). Subjects receiving 0.125% bupivacaine had higher pain scores on arrival to the PACU than did those receiving 0.2% bupivacaine (P = 0.05); there were no other differences in pain scores.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St. Louis Children's Hospital, Missouri 63178.
authors.forename: J B
authors.initials: JB
authors.lastname: Gunter
authors.forename: C M
authors.initials: CM
authors.lastname: Dunn
authors.forename: J B
authors.initials: JB
authors.lastname: Bennie
authors.forename: D L
authors.initials: DL
authors.lastname: Pentecost
authors.forename: R J
authors.initials: RJ
authors.lastname: Bower
authors.forename: J L
authors.initials: JL
authors.lastname: Ternberg
mesh_terms: D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000763:Anesthesia, Caudal; D000768:Anesthesia, General; D002045:Bupivacaine; D002648:Child; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D010149:Postoperative Pain; D011446:Prospective Studies
chemical_list: D002045:Bupivacaine