Adequacy of caudal analgesia in children after penoscrotal and inguinal surgery using 0.5 or 1.0 ml·kg−1 bupivacaine 0.125%

Malviya, Shobha; Fear, D. W.; Roy, W. L.; Lerman, Jerrold

doi:10.1007/bf03008708

Cited by 15 publications

(4 citation statements)

References 16 publications

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“…Although there was no difference in analgesia between the different concentrations, those <0.175% were associated with increased inhalation anesthetic requirements and delayed discharge, whereas concentrations >0.175% were associated with greater complaints of leg weakness and paresthesias. Malviya et al [171] demonstrated that a caudal epidural block with 0.5 ml/kg of 0.125% bupivacaine provided analgesia comparable to 1 ml/kg after peno-scrotal procedures in children. There was a suggestion that 1 ml/kg of 0.125% bupivacaine was superior to 0.5 ml/kg for inguinal procedures.…”

Section: Bupivacainementioning

confidence: 99%

Benefit and Risks of Local Anesthetics in Infants and Children

Gunter

2002

Pediatric Drugs

157

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Regional anesthesia has become a routine part of the practice of anesthesiology in infants and children. Local anesthetic toxicity is extremely rare in infants and children; however, seizures, dysrhythmias, cardiovascular collapse, and transient neuropathic symptoms have been reported. Infants and children may be at increased risk from local anesthetics compared with adults. Larger volumes of local anesthetics are used for epidural anesthesia in infants and children than in adults. Metabolism and elimination of local anesthetics can be delayed in neonates, who also have decreased plasma concentrations of alpha(1)-acid glycoprotein, leading to increased concentrations of unbound bupivacaine. Most regional anesthetic procedures in infants and children are performed with the patient heavily sedated or anesthetized; because of this, and because a test dose is not a particularly sensitive marker of intravenous injection in the anesthetized patient, detection of intravascular local anesthetic injection is extremely difficult. The same local anesthetics used in adult anesthetic practice are also used in infants and children. Because of its extremely short duration of action, chloroprocaine has been used primarily for continuous epidural techniques in infants and children. The use of tetracaine has generally been limited to spinal and topical anesthesia. Lidocaine (lignocaine) has been used extensively in infants and children for topical, regional, plexus, epidural and spinal anesthesia. The association between prilocaine and methemoglobinemia has generally restricted prilocaine use in infants and children to the eutectic mixture of local anesthetics (EMLA). Because of its greater degree of motor block compared with other long-acting local anesthetics, etidocaine has generally been limited to plexus blocks in infants and children. Mepivacaine has been used for both plexus and epidural anesthesia in infants and children. Because postoperative analgesia is often the primary justification for regional anesthesia in infants and children, bupivacaine, a long-acting local anesthetic, is the most commonly reported local anesthetic for pediatric regional anesthesia. Given the lower toxic threshold of bupivacaine compared with other local anesthetics, the risk-benefit ratio of bupivacaine may be greater than that of other local anesthetics. Two new enantiomerically pure local anesthetics, ropivacaine and levobupivacaine, offer clinical profiles comparable to that of bupivacaine but without its lower toxic threshold. The extreme rarity of major toxicity from local anesthetics suggests that widespread replacement of bupivacaine with ropivacaine or levobupivacaine is probably not necessary. However, there are clinical situations, including prolonged local anesthetic infusions, use in neonates, impaired hepatic metabolic function, and anesthetic techniques requiring a large mass of local anesthetic, where replacement of bupivacaine with ropivacaine, levobupivacaine or (for continuous techniques) chloroprocaine appears prudent.

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Section: Bupivacainementioning

confidence: 99%

Benefit and Risks of Local Anesthetics in Infants and Children

Gunter

2002

Pediatric Drugs

157

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“…Analgesia was provided by a single dose caudal block (CB) and rectal administration of mefenamic acid (10–15 mg kg −1 ) before skin incision. CB was performed with a test dose (0.2 ml kg −1 bupivacaine 0.25% with epinephrine 1:200000) and completed with bupivacaine 0.125% (0.3 ml kg −1 for sacral procedures or 0.8 ml kg −1 for lumbar procedures) (10, 11). Epidural block was considered inadequate in those children with >10% increase in HR and/or systolic arterial pressure (SAP) during the first 5 min after skin incision (measurements were performed immediately before incision and every minute for 5 min).…”

Section: Methodsmentioning

confidence: 99%

Similar haemodynamic, respiratory and metabolic changes with the use of sevoflurane or halothane in children breathing spontaneously via a laryngeal mask airway

Erb¹,

Christen²,

Kern³

et al. 2001

Acta Anaesthesiol Scand

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“…However, concerns about the actual level of blockade that would be achieved and inadvertent higher level of blockade always exist. [ 15 ] Therefore, we planned to compare the level of sensory neuraxial blockade achieved by a dose of 0.25% bupivacaine calculated using three commonly used formulae namely, spinal column height-based Spiegel formula (modified for T 10 blockade), body weight-based Takasaki formula, and body weight-based Armitage formula in paediatric patients undergoing infra-umbilical surgeries. [ 7 8 12 ] The primary endpoint of the study was the difference in the number of spinal segments blocked amongst the three groups.…”

Section: Introductionmentioning

confidence: 99%

A randomised study comparing the extent of block produced by spinal column height and body weight-based formulae for paediatric caudal analgesia

2020

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Background and Aims: Height and weight-based formulae are used for calculation of dose of medications for caudal analgesia but these have not been compared. We compared spinal column height-based Spiegel and weight-based Takasaki and Armitage formulae for achieving maximum height of sensory neuraxial block after caudal epidural analgesia in paediatric patients. Methods: In this double-blind randomised study, children aged between 1 and 6 years and planned for infra-umbilical surgery were randomly allocated to receive caudal epidural block (targeting T 10 level block) with 0.25% bupivacaine, using a volume calculated by modified Spiegel formula (group I), Takasaki formula (group II), and Armitage formula (group III). The Institute ethics committee reviewed and approved the study protocol. The primary endpoint of the study was the difference in the number of spinal segments blocked as assessed by pinprick method. The secondary endpoint was the difference in volume of 0.25% bupivacaine used among the groups. The groups were compared using one-way ANOVA. Results: Seventy-five patients (25 in each group) completed the study as per protocol. The mean number of spinal segments blocked was significantly different among groups ( P < 0.001) with patients in group I (13.8 ± 0.83) showing significantly lower number of spinal segments blocked as compared to that in group II (15.8 ± 1.06; P < 0.001), and group III (16.8 ± 1.28; P < 0.001). The mean volume of 0.25% bupivacaine used in group I was significantly lower ( P < 0.001) than that in group II and group III. Conclusion: Dose calculation in caudal epidural analgesia as per spinal column height-based modified Spiegel formula was more precise than bodyweight-based Takasaki and Armitage formulae.

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Adequacy of caudal analgesia in children after penoscrotal and inguinal surgery using 0.5 or 1.0 ml·kg−1 bupivacaine 0.125%

Abstract: Adequacy of caudal analgesia in children after penoscrotal and inguinal surgery using 0.5 or 1.0 ml. kg bupivacaine 0.125 %

Cited by 15 publications

References 16 publications

Benefit and Risks of Local Anesthetics in Infants and Children

Benefit and Risks of Local Anesthetics in Infants and Children

Similar haemodynamic, respiratory and metabolic changes with the use of sevoflurane or halothane in children breathing spontaneously via a laryngeal mask airway

A randomised study comparing the extent of block produced by spinal column height and body weight-based formulae for paediatric caudal analgesia

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