The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions.
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.
Ingelmo
Pablo
P
Department of Anaesthesia and Intensive Care, A.O San Gerardo, Monza, Italy.
Locatelli
Bruno Guido
BG
Frawley
Geoff
G
Knottenbelt
Graham
G
Favarato
Moreno
M
Spotti
Angelica
A
Fumagalli
Roberto
R
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
D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine