New local anesthetics for pediatric anesthesia.
OBJECTIVE
To evaluate the relevance of new local anesthetics in pediatric regional anesthesia.


RESULTS
Several studies evaluate the pharmacokinetics of new local anesthetics, like ropivacaine and levobupivacaine, and compare their safety and efficacy with the old but widely used bupivacaine.


CONCLUSIONS
The goal of anesthetists using regional anesthesia is to use local anesthestics that are as safe and effective as possible, with a rapid onset and a long duration. Even though adequate dose guidelines are available, several toxic effects are reported with the use of bupivacaine in children due to inadvertent intravenous injection, long-term infusion (> 48 h) or administration in newborn babies and infants with reduced metabolism. Ropivacaine and levobupivacaine are new local anesthetics with a wider safety margin that have similar characteristics: both of them are pure S-(-)-enantiomers whose main pharmacological features are less cardio- and neuro-affinity and -toxicity in comparison with the racemic formulae and R-isomers, and a differential neural blockade with less motor than sensory block. Several clinical studies in children compare ropivacaine and levobupivacaine with bupivacaine.
De Negri
Pasquale
P
Department of Anesthesia, Intensive Care and Pain Management, Ospedale Oncologico Regionale, CROB--Cancer Center, Rionero in Vulture, Italy. pdenegri@crob.it
Ivani
Giorgio
G
Tirri
Tiziana
T
Del Piano
Anna Claudia
AC