title: The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions.
abstract: BACKGROUND
  There is no consensus on the concentration or type of local anesthetic used for initiation of epidural anesthesia. The aim of this randomized, double-blind, controlled trial was to compare the clinical effectiveness of epidural administration of both levobupivacaine and bupivacaine in 0.2% and 0.25% concentrations in pediatric patients undergoing abdominal and urological surgery.
  
  
  METHODS
  One hundred and forty-one children scheduled for lower abdominal and urological surgery were randomized to receive 0.4-0.6 ml.kg(-1) epidural, 0.25% bupivacaine, 0.2% bupivacaine, 0.25% levobupivacaine or 0.2% levobupivacaine. Initial epidural volumes, onset times; hemodynamic consequences, postoperative pain scores and degree of residual postoperative motor block were all recorded.
  
  
  RESULTS
  There were no significant differences in the proportion of children with effective analgesia after incision [0.20% bupivacaine 97%, 0.25% bupivacaine 94%, 0.20% levobupivacaine 91%, 0.25% levobupivacaine 92% (P=0.73)] when a median volume of 0.55 ml.kg(-1) was used. There was no association between the volume used for thoracic, lumbar, or sacral epidural anesthesia and the effectiveness of the agents used. There was a significantly greater incidence of pain on awakening with the 0.2% solutions compared with the 0.25% solutions, but no differences in the incidence of residual motor block between groups.
  
  
  CONCLUSIONS
  While there is no difference in the proportion of effective surgical anesthesia, the lower incidence of pain and distress with the 0.25% solutions suggests that this concentration has clinical advantages over the 0.2% solutions for pediatric epidural anesthesia.
authors.affiliation: Department of Anaesthesia and Intensive Care, A.O San Gerardo, Monza, Italy.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ingelmo
authors.forename: Bruno Guido
authors.initials: BG
authors.lastname: Locatelli
authors.forename: Geoff
authors.initials: G
authors.lastname: Frawley
authors.forename: Graham
authors.initials: G
authors.lastname: Knottenbelt
authors.forename: Moreno
authors.initials: M
authors.lastname: Favarato
authors.forename: Angelica
authors.initials: A
authors.lastname: Spotti
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
mesh_terms: D000767:Anesthesia, Epidural; D000779:Anesthetics, Local; D002045:Bupivacaine / Q000031:analogs & derivatives; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D000077554:Levobupivacaine; D008297:Male; D010149:Postoperative Pain / Q000145:classification*; D010372:Pediatrics
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine