Comparison of racemic bupivacaine, ropivacaine, and levo-bupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block.
OBJECTIVE
To compare ropivacaine, levo-bupivacaine, and racemic bupivacaine for caudal blockade in children.


METHODS
Using a prospective observer blinded design, 60 sevoflurane anesthetized children (1 to 7 years) undergoing minor subumbilical surgery, were randomized to receive a caudal block (1 mL/kg) with either ropivacaine 0.2%, racemic bupivacaine 0.25%, or levo-bupivacaine 0.25%. Postoperative analgesia (number of patients needing supplemental analgesia as defined by an objective pain score [OPS] score of > or = 5; time to first analgesic demand) during the first 24 postoperative hours was chosen as the primary end-point. Early postoperative motor block (3-point scale) was assessed as a secondary end-point.


RESULTS
All blocks were judged to be clinically successful based on the presence of adequate intraoperative and early postoperative analgesia. An OPS score > or = 5 was found in 5/20 patients in each study group. No difference regarding the time to first analgesic demand was found between the study groups. The use of ropivacaine (P =.02), but not levo-bupivacaine (P =.18), was found to be associated with less motor block during the first postoperative hour compared with racemic bupivacaine.


CONCLUSIONS
All 3 investigated local anesthetics were found to be clinically comparable despite the slight reduction of early postoperative motor block associated with the use of ropivacaine.
Ivani
Giorgio
G
Department of Anesthesiology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy. gioivani@libero.it
DeNegri
Pasquale
P
Conio
Alessandra
A
Grossetti
Roberto
R
Vitale
Pasquale
P
Vercellino
Claudia
C
Gagliardi
Ferdinando
F
Eksborg
Staffan
S
Lonnqvist
Per-Arne
PA
D000577:Amides / Q000627:therapeutic use*; D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D013237:Stereoisomerism
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine