Efficacy and safety of caudal injection of levobupivacaine, 0.25%, in children under 2 years of age undergoing inguinal hernia repair, circumcision or orchidopexy.
BACKGROUND
Levobupivacaine is the S(-)-enantiomer of racemic bupivacaine. Evidence suggests that it is less cardiotoxic than racemic bupivacaine and the R(+)-enantiomer, dexbupivacaine, while retaining similar local anaesthetic properties and potency to racemic bupivacaine.


METHODS
This was an open study designed to assess the efficacy and safety of 0.25% levobupivacaine administered as a caudal injection at a dose of 2 mg.kg(-1) to 49 paediatric patients aged less than 2 years old undergoing circumcision (group 1), or hernia repair or orchidopexy (group 2).


RESULTS
Adequate analgesia (an increase of <20% in pulse or respiratory rate compared with baseline and an absence of gross movement on application of surgical stimulus) was achieved in 43/48 patients evaluable for efficacy (89.6%). All 22 patients in the circumcision group had adequate analgesia, and two of these patients did not require additional analgesia. The mean time to the use of additional analgesia was 7.3 h. Only one event (a mild rash) was considered possibly related to study medication.


CONCLUSIONS
Levobupivacaine is a promising new local anaesthetic agent for pain management in paediatric patients and appears to offer similar anaesthetic efficacy to racemic bupivacaine with a potentially improved tolerability profile.
Taylor
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Royal Belfast Hospital for Sick Children, Belfast, BT12 6BE, Northern Ireland, UK. drbobtaylor@yahoo.com
Eyres
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Chalkiadis
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GA
Austin
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S
D000763:Anesthesia, Caudal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D002944:Circumcision, Male; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009919:Orchiectomy; D013237:Stereoisomerism; D013997:Time Factors
D000779:Anesthetics, Local; D002045:Bupivacaine