A comparison of epidural bupivacaine, levobupivacaine, and ropivacaine on postoperative analgesia and motor blockade.
In this prospective, randomized, observer-blinded clinical trial, we compared the incidence of unwanted lower extremity motor blockade and the analgesic efficacy between small-dose (0.125%; 0.2 mg x kg(-1) x h(-1)) postoperative epidural infusions of bupivacaine (Group B; n = 28), levobupivacaine (Group L; n = 27), and ropivacaine (Group R; n = 26) in children after hypospadias repair. Motor blockade and pain were assessed at predetermined time points during 48 h by using a modified Bromage scale and the Children's and Infant's Postoperative Pain Scale (CHIPPS). Postoperative analgesia was almost identical in all three study groups (CHIPPS range, 0-3), with no need for the administration of supplemental analgesia in any patient. However, significantly more patients in Group B (n = 6; P = 0.03) displayed signs of unwanted motor blockade during the observation period compared with Group L (n = 0) and Group R (n = 0). In conclusion, significantly less unwanted motor blockade was associated with postoperative epidural infusions of 0.125% levobupivacaine or ropivacaine in children after hypospadias repair as compared with a similar infusion of bupivacaine. However, no difference with regard to postoperative analgesia could be detected among the three different local anesthetics studied.
*Department of Anesthesia, ICU and Pain Management, Centro di Riferimento Oncologico della Basilicata-Cancer Center, Rionero in Vulture, Potenza, Italy; †Department of Pediatric Anesthesia and Intensive Care Unit, "Regina Margherita" Children's Hospital, Turin, Italy; and ‡Department of Women and Child Health and Department of Surgical Sciences, Karolinska Institute, Stockholm, Sweden.
Pasquale
P
De Negri
Giorgio
G
Ivani
Tiziana
T
Tirri
Pasqualina
P
Modano
Cesare
C
Reato
Staffan
S
Eksborg
Per-Arne
PA
Lonnqvist
D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D015360:Analgesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006801:Humans; D007021:Hypospadias / Q000601:surgery; D008297:Male; D019148:Neuromuscular Blockade; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine; D013237:Stereoisomerism
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine