Levobupivacaine 0.25% compared with ropivacaine 0.25% by the caudal route in children

Astuto, Marinella; Disma, Nicola; Arena, C.

doi:10.1017/s0265021503001339

Cited by 16 publications

(21 citation statements)

References 14 publications

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“…Previous studies have indicated that caudal block with high volume ⁄ low concentration is more effective than low volume ⁄ high concentration of local anaesthetic in blocking spermatic cord traction response during orchidopexy [12]. In general, the concentration of levobupivacaine used in paediatric caudal block is commonly 0.25% [5,[13][14][15]. Based on our current results, 0.15% levobupivacaine might represent a more suitable concentration for caudal blockade in children.…”

Section: Discussionsupporting

confidence: 49%

The optimum concentration of levobupivacaine for intra‐operative caudal analgesia in children undergoing inguinal hernia repair at equal volumes of injectate

Chen¹,

Wang

Tan

2008

Anaesthesia

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SummaryProbit analysis was used to predict the median effective concentration (EC 50 ) and the 95% effective concentration (EC 95 ) values of levobupivacaine for caudal analgesia in children at equal volumes of injectate. Sixty children scheduled for inguinal herniorrhaphy were recruited. Anaesthesia was induced with sevofurane and nitrous oxide. Then caudal block (total volume of local anaesthetic 1 ml.kg )1 ) was performed. Patients randomly received one of six concentrations (0.08%, 0.10%, 0.12%, 0.14%, 0.16% or 0.18%) of levobupivacaine. Thereafter, inhalational anaesthetics were discontinued and intravenous midazolam 0.1 mg.kg )1 was administered to maintain sedation. The effective caudal analgesia was defined as an absence of gross movements and a haemodynamic (heart rate or blood pressure) reaction < 20% compared with baseline in response to surgical incision. Our data indicated that the EC 50 and EC 95 values of levobupivacaine for caudal analgesia were 0.109% (95% confidence intervals 0.098-0.120%) and 0.151% (95% confidence intervals 0.135-0.193%) when using the same volume (1 ml.kg )1 ), respectively. Caudal anaesthesia in children is usually performed after an inhaled or intravenous (i.v.) induction and is a useful adjunct for providing postoperative analgesia after genital, lower abdominal, and lower limb operations. It can reduce the amount of inhaled and intravenous anaesthetic required, attenuate the stress response to surgery, facilitate a rapid and smooth recovery, and provide good immediate postoperative analgesia. Levobupivacaine, the S-enantiomer of bupivacaine, has been promoted as an alternative to (with less cardiotoxicity than) racemic bupivacaine [1,2]. Despite extensive use in children [3][4][5], the optimal concentration of levobupivacaine in caudal blockade remains to be established. The minimum local analgesic concentration (MLAC) has been developed as a useful clinical measure of epidural analgesia [6,7]. Unfortunately, MLAC studies only describe one point of the dose-response curve, the effective dose in 50% of the population and do not provide information about the shape or slope of the curve. Indeed, the 95% effective concentration (EC 95 ) would often be more clinically relevant. We hypothesised that the clinical effect of levobupivacaine in caudal analgesia in children varied with the dose used (at equal volumes of injectate), and the purpose of our study was to describe the full dose-response relation of levobupivacaine in this context. MethodsAfter approval by the Hospital Research Ethics Committee and informed written consent from parents, sixty ASA status I children, aged 1-3 years scheduled for elective inguinal herniorrhaphy were enrolled. Children with neurological, neuromuscular, psychiatric or blood clotting disorders or with a known allergy to local anaesthetics were excluded.All children were starved > 6 h but not premedicated. In the operating room, the patients were monitored with electrocardiography, pulse oximetry, heart rate (HR) respiratory rate (RR), and no...

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Section: Discussionsupporting

confidence: 49%

The optimum concentration of levobupivacaine for intra‐operative caudal analgesia in children undergoing inguinal hernia repair at equal volumes of injectate

Chen¹,

Wang

Tan

2008

Anaesthesia

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“…However, other studies [1,17] indicated that caudal blocks with high volume/low concentration of LA, or vice versa, were more effective in blocking spermatic cord traction response during orchidopexy, but the investigated dose in both cases (2 mg • kg -1 ) was higher than the dose administered in our first group (1.5 mg • kg -1 ). Because pediatric patients were involved in this study, the doses of LA used were reduced and thereby toxicity of LA was avoided similar to other studies [7,[18][19][20] that did not report adverse events of LA when the recommended dose of 2.5 mg • kg -1 was used. However, adequate care should be taken regarding pediatric patients as recommended previously [21,22] .…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Three Different Volumes of Levobupivacaine for Caudal Block in Children Undergoing Orchidopexy and Inguinal Hernia Repair

Marjanović¹,

Budić²,

Stević

et al. 2017

Med Princ Pract

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Objective: The aim of this study was to compare the efficacy of 3 different volumes of 0.25% levobupivacaine caudally administered on the effect of intra- and postoperative analgesia in children undergoing orchidopexy and inguinal hernia repair. Subjects and Methods: Forty children, aged 1-7 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomized into 3 different groups according to the applied volumes of 0.25% levobupivacaine: group 1 (n = 13): 0.6 mL∙kg^-1; group 2 (n = 10): 0.8 mL∙kg^-1; and group 3 (n = 17): 1.0 mL∙kg^-1. The age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were compared among the groups. The time to first use of the analgesic and the number of patients who required analgesic 24 h after surgery in the time intervals within 6 h, between 6 and 12 h, and between 12 and 24 h postoperatively were evaluated among the groups. Statistical analyses were performed with a Dunnett t test, ANOVA, or Kruskal-Wallis test and χ² test. Logistic regression analysis was used in order to examine predictive factors on duration of postoperative analgesia. Results: Age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were similar among the groups. The time to first analgesic use did not differ among the groups, and logistic regression modelling showed that using the 3 different volumes of levobupivacaine had no predictive influence on duration of postoperative analgesia. The numbers of patients who required analgesics within 6 h (3/2/3), between 6 and 12 h (3/1/3), and between 12 and 24 h (1/0/2) after surgery were similar among the groups. Conclusion: The 3 different volumes of 0.25% levobupivacaine provided the same quality of intra- and postoperative pain relief in pediatric patients undergoing orchidopexy and inguinal hernia repair.

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“…So far, very few studies have been published comparing ropivacaine and levobupivacaine for regional anesthesia in children. [101112]…”

Section: Discussionmentioning

confidence: 99%

Caudal epidural analgesia in pediatric patients: Comparison of 0.25% levobupivacaine and 0.25% ropivacaine in terms of motor blockade and postoperative analgesia

2017

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Context:Ropivacaine and Levo-Bupivacaine have been safely used for caudal anaesthesia in children, but there are limited studies comparing the efficacy of 0.25% Ropivacaine and 0.25% Levo-Bupivacaine for caudal anaesthesia in infraumbilical surgeries.Aims:The aim of this study was to compare the incidence of motor blockade and postoperative analgesia with 0.25% ropivacaine and 0.25% levobupivacaine for the caudal block in children receiving infraumbilical surgery.Settings and Design:This was a randomized double-blinded study.Subjects and Methods:Sixty patients of either sex, between 1 and 10 years posted for elective infraumbilical surgeries, to receive caudal block with either (Group R) ropivacaine 0.25% or (Group L) levobupivacaine 0.25% of volume 1 ml/kg were included in the study. Motor blockade was assessed using motor power scale, and pain was assessed every 1 h for first 6 h, then 2nd hourly for following 18 h using modified Hannallah objective pain scale. If pain score is ≥4, the patients were given paracetamol suppositories 20 mg/kg as rescue analgesia.Statistical Analysis Used:All analyses were performed using Chi-square test, Student's independent t-test, Kruskal–Wallis test, Mann–Whitney U-test.Results:The time for full motor recovery was similar in both groups; in Group R, ropivacaine: 180.50 ± 14.68 min, and in Group L, levobupivacaine: 184.50 ± 18.02 min, with P = 0.163. The duration of postoperative pain relief between the groups was 330.50 ± 9.54 min in Group L (levobupivacaine) and 312.67 ± 5.56 min in Group R (ropivacaine) with P = 0.165 not statistically significant.Conclusions:Both ropivacaine 0.25% and levobupivacaine 0.25% have similar recovery from motor blockade and postoperative analgesia.

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Levobupivacaine 0.25% compared with ropivacaine 0.25% by the caudal route in children

Abstract: We conclude that levobupivacaine 0.25% 1 mL kg(-1) provides caudal block of comparable onset and duration, as produced by the same volume and concentration of ropivacaine.

Cited by 16 publications

References 14 publications

The optimum concentration of levobupivacaine for intra‐operative caudal analgesia in children undergoing inguinal hernia repair at equal volumes of injectate

The optimum concentration of levobupivacaine for intra‐operative caudal analgesia in children undergoing inguinal hernia repair at equal volumes of injectate

A Comparison of Three Different Volumes of Levobupivacaine for Caudal Block in Children Undergoing Orchidopexy and Inguinal Hernia Repair

Caudal epidural analgesia in pediatric patients: Comparison of 0.25% levobupivacaine and 0.25% ropivacaine in terms of motor blockade and postoperative analgesia

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