title: Caudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double-blind, randomized, controlled trial.
abstract: BACKGROUND
  We hypothesized that without the analgesic effects of volatile anesthetics, caudal 0.20% ropivacaine would be less effective during surgical stimulation than 0.20% bupivacaine or 0.20% levobupivacaine. This trial was designed to examine whether the combination of a caudal block with 0.20% ropivacaine and i.v. anesthesia resulted in reduced analgesic efficacy during surgery compared with caudal 0.20% levobupivacaine or 0.20% bupivacaine in children.
  
  
  METHODS
  Ninety ASA I-II children between 1 and 7 years old, scheduled for inguinal hernia repair or orchidopexy under propofol anesthesia were randomized to receive a caudal block with 1 ml x kg(-1) of 0.2% bupivacaine, 0.2% ropivacaine or 0.2% levobupivacaine. The primary outcome measure of the study was the clinical efficacy of the caudal block during surgery. Secondary outcome measures were postoperative pain relief and residual motor blockade.
  
  
  RESULTS
  Four children were excluded and 86 were analyzed. The proportion of children with effective caudal block during surgery was significantly higher in children receiving levobupivacaine (26/28) or bupivacaine (27/29) compared with patients receiving ropivacaine (21/29) (P = 0.03). There were no significant differences among groups in the analgesic onset time (P = 0.1), incidence of residual motor blockade (P = 0.4), number of patients requiring analgesia after operation or in the time from caudal injection to the first administration of analgesic medication (P = 0.3).
  
  
  CONCLUSIONS
  Combined with propofol anesthesia, 0.2% levobupivacaine and 0.2% bupivacaine are more effective than 0.2% ropivacaine for caudal use in children undergoing inguinal hernia repair or orchidopexy.
authors.affiliation: Anaesthesia and Intensive Care Department, Ospedali Riuniti di Bergamo, Bergamo, Italy. pabloingelmo@libero.it
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Ingelmo
authors.forename: Bruno G
authors.initials: BG
authors.lastname: Locatelli
authors.forename: Valter
authors.initials: V
authors.lastname: Sonzogni
authors.forename: Chiara
authors.initials: C
authors.lastname: Gattoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Cadisco
authors.forename: Monia
authors.initials: M
authors.lastname: Lorini
authors.forename: Gloria N
authors.initials: GN
authors.lastname: Sora
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
mesh_terms: D000577:Amides / Q000494:pharmacology*; D000758:Anesthesia; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000494:pharmacology*; D002420:Cauda Equina / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D000077554:Levobupivacaine; D008297:Male; D009043:Motor Activity / Q000187:drug effects; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000077212:Ropivacaine; D000077554:Levobupivacaine; D002045:Bupivacaine