Comparative evaluation of caudal block administration of ropivacaine, levobupivacaine and bupivacaine in pediatric patients undergoing lower- abdominal surgeries

https://doi.org/10.53730/ijhs.v6nS6.13174

Authors

  • Melvin Cyriac Assistant Professor, Department of Anaesthesia, Dr. Moopen's Medical College, Wayanad, Kerala, India
  • Arjun P. S. Assistant Professor, Department of Anaesthesia, Dr. Moopen's Medical College, Wayanad, Kerala, India
  • Ganesh P. Subbaiah Associate Professor, Department of Orthopaedics, Dr. Moopen's Medical College, Wayanad, Kerala, India
  • Vinutha Ganesh Assistant Professor, Department of Anaesthesia, Dr. Moopen's Medical College, Wayanad, Kerala, India

Keywords:

analgesia, bupivacaine, caudal block, motor block, pediatric patients

Abstract

Aim: The purpose of the present research was to assess and compare the efficacy of Ropivacaine, Levobupivacaine and Bupivacaine in paediatric patients as an anaesthetic in caudal block undergoing various lower abdominal surgeries. Methodology: This was a prospective randomized controlled study including 50 consecutive patients in the age group of 1‑10 years, who underwent urogenital surgeries under general anesthesia. Study was performed at Dr. Moopen's Medical College, Wayanad, Kerala. India and duration was from January 2022 to September 2022. Caudal block was given with either bupivacaine (0.25%) 1 ml/kg (Group I) or ropivacaine (0.25%) 1 ml/kg (Group II) or levobupivacaine 0.25% 1 mL /kg (Group III). Heart rate (HR) and systolic blood pressure (SBP) were recorded as a baseline, before the anesthesia induction and then at 30, 60 and 90 min after incision. Pain scores were assessed post‑operatively by a single observer at 30 min and then at 2, 4, 8 and 12 hour with a 5‑point observer pain score (OPS). Patients and observer were blinded to the medication given. The duration of absolute analgesia was defined as the time from caudal injection until the pain score was >2. Motor block was assessed by modified Bromage scale. 

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References

Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr. 1993;122:387-391. DOI: 10.1016/S0022- 3476(11)80004-1

Bosenberg A, Thomas J, Lopez T, Lybeck A, Huizar K, Larsson LE. The efficacy of caudal ropivacaine 1, 2 and 3 mg x l(-1) for postoperative analgesia in children. Paediatr Anaesth. 2002;12:53-58. DOI: 10.1046/j.1460- 9592.2002.00769.

Breschan C, Jost R, Krumpholz R, Schaumberger F, Stettner H, Marhofer P, et al. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine, and bupivacaine in pediatric patients undergoing caudal blockade. Pediatr Anaesth. 2005;15:301-306. DOI: 10.1111/ j.1460-9592.2004.01443.

DeVera HV, Furukawa KT, Matson MD, Scavone JA, James MA. Regional techniques as an adjunct to general anesthesia for pediatric extremity and spine surgery. Journal of Pediatric Orthopaedics. 2006 Nov 1;26(6):801-4.

Dobereiner EF, CoxRG, Ewen A, Lardner DR. Evidence based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects? Can J Anaesth 2010;57:1102 10.

Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 2000; 59: 551–579.

Gunter JB. Benefit and risks of local anesthetics in infants and children. Paediatr Drugs. 2002;4:649-672.

Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998; 86: 797–804.

Ingelmo PM, Locatelli BG, Sonzogni V, Gattoni C, Cadisco A, Lorini M, et al. Caudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double blind, randomized, controlled trial. Pediatr Anaesth. 2006;16:955-961. DOI: 10.1111/j.1460- 9592.2006.01903.

Ivani G, DeNegri P, Conio A, et al. Comparison of racemic bupivacaine, ropivacaine and levo-bupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block. Reg Anesth Pain Med 2002; 27: 157–161.

Ivani G, Lampugnani E, Torre M, Calevo Maria G, DeNegri P, Borrometi F, et al. Comparison of ropivacaine with bupivacaine for paediatric caudal block. Br J Anaesth 1998;81:247 8.

Khalil S, Lingadevaru H, Bolos M, Rabb M, Matuszczak M, Maposa D et al. Caudal regional anesthesia, ropivacaine concentration, postoperative analgesia, and infants. Anesth Analg. 2006;102:395-399. DOI: 10.1213/01. ane.0000194590.82645.4c

Knudsen K, Suurküla MB, Blomberg S, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78:507-514. DOI: 10.1093/ bja/78.5.507

Lerman J, Strong HA, LeDez KM, Swartz J, Rieder MJ, Burrows FA. Effects of age on the serum concentration of alpha 1-acid glycoprotein and the binding of lidocaine in pediatric patients. Clin Pharmacol Ther. 1989;46(2):219-225. DOI: 10.1038/clpt.1989.129

Locatelli B, Ingelmo P, Sonzogni V, Zanella A, Gatti V, Spotti A, et al. Randomized, double blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children. Br J Anaesth 2005;94:366 71.

Marhofer P, Koinig H, Kapral S. The choice of drugs for caudal anesthesia in children. An overview. Anaesthesist 2003;52:55 67.

Murdoch JA, Dickson UK, Wilson PA, Berman JS, Gad-Elrab RR, Scott NB. The efficacy and safety of three concentrations of levobupivacaine administered as a continuous epidural infusion in patients undergoing orthopedic surgery. Anesth Analg 2002; 94: 438–444.

Polley L S, Columb MD, Naughton NN et al: Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labour: Implications for therapeutic indexes. Anaesthesiology 1999; 90(4): 944-50.

Polley LS, Columb MO, Naughton NN, Wagner DS, van de Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology. 1999;90:944-950. DOI:10.1097/00000542-199904000-00003

Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acut toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563-569.

Wolf AR, Valley RD, Fear DW, Roy WL, Lerman J. Bupivacaine for caudal analgesia in infants and children: the optimal effective concentration. Anesthesiology. 1988;69:102-106.

Published

01-10-2022

How to Cite

Cyriac, M., Arjun, P. S., Subbaiah, G. P., & Ganesh, V. (2022). Comparative evaluation of caudal block administration of ropivacaine, levobupivacaine and bupivacaine in pediatric patients undergoing lower- abdominal surgeries. International Journal of Health Sciences, 6(S6), 11441–11447. https://doi.org/10.53730/ijhs.v6nS6.13174

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Peer Review Articles