title: Caudal-epidural bupivacaine versus ropivacaine with fentanyl for paediatric postoperative analgesia.
abstract: OBJECTIVE
  Caudal-epidural, the most commonly used regional analgesia technique, is virtually free of measurable hemodynamic effects, thus adding a new dimension to the evolving necessity of pediatric postoperative pain management. Though, bupivacaine is the most commonly used drug for this purpose, ropivacaine has emerged as a safer alternative, with the addition of opioids, like fentanyl, increasing the effective duration of analgesia. With this overview, our present study was designed to compare the postoperative analgesic efficacy of bupivacaine-fentanyl and ropivacaine-fentanyl combinations by caudal-epidural technique in pediatric infraumbilical surgeries.
  
  
  METHODS
  Totally, 60 pediatric patients, of either sex, aged between 2 and 8 years, American Society of Anesthesiologists physical status I and II, undergoing elective infraumbilical surgeries were assigned into two groups, Group BF receiving bupivacaine 0.25%, 0.7 ml/kg and Group RF receiving ropivacaine 0.25%, 0.7 ml/kg with fentanyl 1 μg/kg added to each group. Assessment of pain was done using "Hannallah pain scale." Consumption of the total amount of rescue analgesic and time to requirement of the first dose, as also duration of motor blockade were noted. Perioperative hemodynamics and any adverse effects were monitored at regular intervals.
  
  
  RESULTS
  The RF Group experienced significantly longer duration of effective postoperative analgesia, with significantly shorter duration of motor blockade and lesser total analgesic requirement in comparison to the BF Group. Hemodynamically, patients in both the groups, were equally stable.
  
  
  CONCLUSIONS
  Ropivacaine, with an equipotent analgesic efficacy and a lesser duration of motor block, can be used as an alternative to bupivacaine for pediatric postoperative pain care through the caudal route.
authors.affiliation: Department of Anaesthesiology and Critical Care, Medical College and Hospital, Kolkata, India.
authors.forename: Swapnadeep
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: Department of Anaesthesiology and Critical Care, Medical College and Hospital, Kolkata, India.
authors.forename: Sudakshina
authors.initials: S
authors.lastname: Mukherji
authors.affiliation: Department of Anaesthesiology and Critical Care, IQ City Medical College, Durgapur, India.
authors.forename: Jagabandhu
authors.initials: J
authors.lastname: Sheet
authors.affiliation: Department of Anaesthesiology and Critical Care, College of Medicine and JNM Hospital, Kalyani, India.
authors.forename: Anamitra
authors.initials: A
authors.lastname: Mandal
authors.affiliation: Department of Anaesthesiology and Critical Care, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India.
authors.forename: Sarbari
authors.initials: S
authors.lastname: Swaika
keywords: Bupivacaine; caudal-epidural analgesia; fentanyl; pediatric postoperative pain management; ropivacaine