title: Prospective, randomized, double-blinded comparison of the effects of caudally administered levobupivacaine 0.25% and bupivacaine 0.25% on pain and motor block in children undergoing circumcision surgery.
abstract: BACKGROUND
  Caudal anesthesia is widely used as intraoperative and postoperative analgesia in children's subumbilical surgeries such as on the urogenital system, lower extremities and lower abdomen to reduce the stress response to surgery and to facilitate the general anesthesia.
  
  
  OBJECTIVE
  The purpose of this study was to compare the effects of caudally administered bupivacaine and levobupivacaine of equal volume and concentration on motor block and postoperative pain in children undergoing circumcision surgery.
  
  
  METHODS
  The prospective, randomized, double-blind study included 60 patients with ages ranging from 1-10 years and ASA (American Society of Anesthesiologists) physical status of I-II who underwent elective circumcision surgery. The patients were divided into two groups: group B received 0.5 ml/kg of bupivacaine 0.25% caudally and group L received 0.5 ml/kg of levobupivacaine 0.25% caudally. Postoperative pain was assessed by children's and infant's postoperative pain scale and motor block was assessed by the Bromage scale.
  
  
  RESULTS
  The mean children's and infant's postoperative pain scale of group B was significantly lower than that of group L (p < 0.001). Three patients in group B and seven patients in group L needed additional analgesia after the incision. There was no significant difference between groups in terms of Bromage scores and in both groups the residual motor block was found to be zero at the 150th minutes.
  
  
  CONCLUSIONS
  According to these findings, bupivacaine has an adequate quality of analgesia than levobupivacaine. We suggest that bupivacaine for caudal block at the concentration of 0.25% (0.5 ml/kg) provides an adequate level of analgesia for outpatient circumcision surgery.
authors.affiliation: Department of Anesthesiology and Reanimation, Gaziosmanpasa University School of Medicine Tokat, Turkey. zkayaahz@gmail.com
authors.forename: Z
authors.initials: Z
authors.lastname: Kaya
authors.forename: M
authors.initials: M
authors.lastname: Süren
authors.forename: S
authors.initials: S
authors.lastname: Arici
authors.forename: S
authors.initials: S
authors.lastname: Karaman
authors.forename: H
authors.initials: H
authors.lastname: Tapar
authors.forename: F
authors.initials: F
authors.lastname: Erdemir
mesh_terms: D000556:Ambulatory Surgical Procedures; D000700:Analgesics / Q000627:therapeutic use; D000763:Anesthesia, Caudal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000009:adverse effects*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D006801:Humans; D007223:Infant; D000077554:Levobupivacaine; D008297:Male; D009043:Motor Activity / Q000187:drug effects*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine