title: [Levobupivacaine versus racemic bupivacaine for thoracic and upper lumbar epidural anesthesia-analgesia in children].
abstract: OBJECTIVE
  We compared levobupivacaine to bupivacaine for epidural analgesia for thoracic or upper abdominal surgery in children. Our working hypothesis was that at equivalent doses levobupivacaine and bupivacaine behave in the same way.
  
  
  METHODS
  ASA 1-4 patients between the ages of 5 and 16 years were randomized to a levobupivacaine or a bupivacaine group. After general anesthesia was induced, we inserted a thoracic or upper lumbar epidural catheter and administered a dose of 0.25% bupivacaine or levobupivacaine (1 mgxkg(-1)) while maintaining general anesthesia. Analgesia was provided with an epidural infusion of 0.125% bupivacaine or levobupivacaine with fentanyl. Fentanyl was used as a perioperative rescue analgesic and metamizole magnesium as a postoperative rescue analgesic. The epidural infusion was reduced by 25% each day beginning on the second day. We analyzed hemodynamic and respiratory variables, rescue analgesia, time until extubation and discharge from the recovery unit, complications associated with the technique, adverse effects, and degree of comfort achieved.
  
  
  RESULTS
  We studied 64 patients; 33 received levobupivacaine and 31 bupivacaine. Mean (SD) duration of recovery unit stay was significantly longer in the bupivacaine group (4.2 [0.99] days) than in the levobupivacaine group (35 [0.6] days; P<.05). Significantly more patients needed perioperative rescue analgesia in the levobupivacaine group (n=6 [18.18%]) than in the bupivacaine group (n=3 [9.67%]; P<.01). After 48 hours, the need for postoperative rescue analgesia was significantly lower with levobupivacaine (P<.01). Motor block was significantly greater with bupivacaine (P<05). Adverse effects and complications included 2 cases of persistent bradycardia and 1 case of dural puncture with no subsequent clinical manifestations.
  
  
  CONCLUSIONS
  This experience with epidural anesthesia for thoracic and upper abdominal surgery showed levobupivacaine and racemic bupivacaine to have similar profiles. Levobupivacaine, which is less toxic, could be used to replace bupivacaine in children.
authors.affiliation: Hospital Infantil Universitario "Niño Jesús" de Madrid. joscalvo@ya.com
authors.forename: J M
authors.initials: JM
authors.lastname: Calvo Vecino
authors.forename: L
authors.initials: L
authors.lastname: San Norberto
authors.forename: A
authors.initials: A
authors.lastname: Abad Gurumeta
authors.forename: D
authors.initials: D
authors.lastname: Velasco Villanueva
authors.forename: M F
authors.initials: MF
authors.lastname: Velásquez Muñoz
authors.forename: S
authors.initials: S
authors.lastname: Pico Brezmes
authors.forename: A
authors.initials: A
authors.lastname: Pérez Gallardo
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods*; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000031:analogs & derivatives; D002648:Child; D002675:Child, Preschool; D006801:Humans; D000077554:Levobupivacaine; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine