Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children †

Locatelli, Bruno Guido; Ingelmo, Pablo; Sonzogni, Valter; Zanella, Alberto; Gatti, Valentina; Spotti, Angelica; Marco, Salvatore Di; Fumagalli, Roberto

doi:10.1093/bja/aei059

Cited by 90 publications

(90 citation statements)

References 20 publications

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“…For subumbilical surgery, Locatelli compared identical concentrations of caudally administered levobupivacaine, ropivacaine, and bupivacaine. Analgesic efficacy was similar among all three groups but bupivacaine resulted in a greater incidence of residual motor blockade and a longer analgesic block than the other two agents (18).…”

Section: Discussionmentioning

confidence: 79%

Caudal Additives Do Not Improve the Analgesia Afforded by Levobupivacaine After Hypospadias Repair

2012

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Section: Discussionmentioning

confidence: 79%

Caudal Additives Do Not Improve the Analgesia Afforded by Levobupivacaine After Hypospadias Repair

2012

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“…Seventeen such RCTs were reviewed in detail using a structured methodology. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Two review articles were also identified. 18,19 The reference lists for all of these 19 publications were reviewed to identify any further RCTs that may have been missed with the initial search strategy; no such study was found.…”

Section: Methodsmentioning

confidence: 99%

“…Thirteen studies showed no difference in the duration; four studies showed a difference. Of these four, the first study 2 showed a longer duration of analgesia with bupivacaine compared with levobupivacaine or ropivacaine, as judged by Children's and Infant's Postoperative Pain Scale score and the need for analgesia. Somewhat predictably, the second study 5 showed a shorter duration of postoperative analgesia with 0.1% ropivacaine compared with 0.2% ropivacaine or bupivacaine.…”

Section: Relative Efficacymentioning

confidence: 99%

Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects?

Dobereiner

Cox

Ewen

et al. 2010

Can J Anesth/J Can Anesth

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“…In the caudal block group, all children received a test dose of 0.2 ml.kg )1 bupivacaine 0.25% + epinephrine 1 : 200 000 followed by 0.8 ml.kg )1 bupivacaine 0.175%, whereas in the control group, no intervention took place. Finally, all children were turned back to the supine position and after 15 min the second set of measurements was performed; the effectiveness of the caudal block was assessed by pinching the skin at the level L1 and absence of movement was judged to be an effective block [7]. For the FRC measurements, an ultrasonic transit-time airflow meter (Exhalyzer D with ICU insert, Eco Medics, Duernten, Switzerland), which simultaneously measures flow and molar mass of the breathing gas, was placed between the fresh gas supply and the laryngeal mask airway.…”

Section: Methodsmentioning

confidence: 99%

The effect of caudal block on functional residual capacity and ventilation homogeneity in healthy children*

Ungern‐Sternberg¹,

Regli²,

Frei³

et al. 2006

Anaesthesia

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SummaryCaudal block results in a motor blockade that can reduce abdominal wall tension. This could interact with the balance between chest wall and lung recoil pressure and tension of the diaphragm, which determines the static resting volume of the lung. On this rationale, we hypothesised that caudal block causes an increase in functional residual capacity and ventilation distribution in anaesthetised children. Fifty-two healthy children (15-30 kg, 3-8 years of age) undergoing elective surgery with general anaesthesia and caudal block were studied and randomly allocated to two groups: caudal block or control. Following induction of anaesthesia, the first measurement was obtained in the supine position (baseline). All children were then turned to the left lateral position and patients in the caudal block group received a caudal block with bupivacaine. No intervention took place in the control group. After 15 min in the supine position, the second assessment was performed. Functional residual capacity and parameters of ventilation distribution were calculated by a blinded reviewer. Functional residual capacity was similar at baseline in both groups. In the caudal block group, the capacity increased significantly (p < 0.0001) following caudal block, while in the control group, it remained unchanged. In both groups, parameters of ventilation distribution were consistent with the changes in functional residual capacity. Caudal block resulted in a significant increase in functional residual capacity and improvement in ventilation homogeneity in comparison with the control group. This indicates that caudal block might have a beneficial effect on gas exchange in anaesthetised, spontaneously breathing preschool-aged children with healthy lungs. Various anaesthetic agents, airway instrumentations and ventilation strategies are used in infants and children undergoing anaesthesia. Each of these factors may affect functional residual capacity (FRC), which is one of the most important respiratory parameters of gas exchange. There is very little information available on the magnitude and the relative contribution of these different factors (e.g. neuroaxial blockade with local anaesthetics) on functional residual capacity in anaesthetised children [1][2][3][4].Muscle relaxation induced by caudal epidural anaesthesia with bupivacaine decreases abdominal muscle tone while sparing the muscles of the respiratory system (diaphragm, intercostal muscles). This could interact with the balance between chest wall and lung recoil pressure and tension of the diaphragm, which determines the static resting volume of the lung. This alteration of the equilibrium between the thoracal and abdominal compartments might affect the functional residual capacity and ventilation homogeneity of the lungs. This study

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Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children †

Abstract: During sub-umbilical surgery, caudal levobupivacaine, ropivacaine and bupivacaine provided comparable analgesic efficacy. Bupivacaine produced a higher incidence of residual motor blockade and a longer analgesic block than ropivacaine and levobupivacaine.

Cited by 90 publications

References 20 publications

Caudal Additives Do Not Improve the Analgesia Afforded by Levobupivacaine After Hypospadias Repair

Caudal Additives Do Not Improve the Analgesia Afforded by Levobupivacaine After Hypospadias Repair

Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects?

The effect of caudal block on functional residual capacity and ventilation homogeneity in healthy children*

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