title: A comparison of three different concentrations of levobupivacaine for caudal block in children.
abstract: We investigated three different concentrations of levobupivacaine (0.125%, 0.20%, and 0.25%; n = 20 in each group) for caudal blockade in a prospective, randomized, observer-blinded fashion in children (1-7 yr) undergoing subumbilical surgery. The duration of postoperative analgesia was assessed as the time to first administration of supplemental analgesia (based on a Childrens and Infants Postoperative Pain Scale score of >or=4), and the degree of immediate postoperative motor blockade was determined by use of a 3-point scale. A dose-response relationship was observed both with regard to median duration of postoperative analgesia (0.125%, 60 min; 0.20%, 118 min; 0.25%, 158 min) and the number of patients with evidence of early postoperative motor blockade (0.125%, 0; 0.20%, 4; 0.25%, 8). The 0.125% concentration was associated with significantly less early motor blockade (P = 0.003) but was found to result in a significantly shorter duration of postoperative analgesia (P < 0.05). Based on these results, the use of 0.20% levobupivacaine might represent the best clinical option if a plain levobupivacaine solution is to be used for caudal blockade in children.
  
  
  CONCLUSIONS
  The use of 0.125% levobupivacaine for caudal blockade (1 mL/kg) in children (1-7 yr) was associated with less early postoperative motor blockade but a shorter duration of postoperative analgesia compared with 0.20% and 0.25% solutions.
authors.affiliation: *Department of Anesthesiology and Intensive Care Unit, Regina Margherita Children's Hospital, Turin; †Department of Anesthesiology, Intensive Care Unit, and Pain Management, "CROB" Cancer Center, Rionero in Vulture, Italy; ‡Department of Paediatric Anaesthesia and Intensive Care, Astrid Lindgrens Children's Hospital, Karolinska Hospital; and §Karolinska Pharmacy and Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ivani
authors.forename: Pasquale
authors.initials: P
authors.lastname: De Negri
authors.forename: Per-Arne
authors.initials: PA
authors.lastname: Lonnqvist
authors.forename: Staffan
authors.initials: S
authors.lastname: Eksborg
authors.forename: Valeria
authors.initials: V
authors.lastname: Mossetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Grossetti
authors.forename: Simona
authors.initials: S
authors.lastname: Italiano
authors.forename: Franca
authors.initials: F
authors.lastname: Rosso
authors.forename: Federica
authors.initials: F
authors.lastname: Tonetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Codipietro
mesh_terms: D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005832:Genital Diseases, Male / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007223:Infant; D000077554:Levobupivacaine; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine