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Ropivacaine 0.25% compared with bupivacaine 0.25% by the caudal route
M J Da Conceicao1, L Coelho, M Khalil
1Discipline of Anaesthesiology, Santa Catarina Federal University and Hospital Infantil Joana de Gusmao, Florianopolis, Brazil.
Insights
Ropivacaine provides effective caudal anesthesia in children, offering similar pain relief to bupivacaine but with a significantly shorter duration of motor block, improving postoperative recovery.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
Background:
- Caudal anesthesia is commonly used in pediatric patients.
- Evaluating new local anesthetics for pediatric use is crucial for optimizing pain management and recovery.
Purpose of the Study:
- To compare the efficacy and safety of ropivacaine versus bupivacaine for caudal anesthesia in children.
- To assess postoperative analgesia and the degree of motor block.
Main Methods:
- A randomized, double-blind study involving 80 pediatric patients (2-5 years old).
- Patients received either ropivacaine 0.25% or bupivacaine 0.25% via caudal block.
- Motor block was assessed using a modified Bromage scale, and time to first analgesic requirement was recorded.
Main Results:
- No significant differences in hemodynamic parameters or adverse events were observed between the groups.
- Ropivacaine group demonstrated a significantly shorter duration of motor block compared to the bupivacaine group (P<0.05).
- The time to the first postoperative analgesic requirement was comparable between the two anesthetic groups.
Conclusions:
- Ropivacaine 0.25% is an effective local anesthetic for caudal anesthesia in pediatric patients.
- Ropivacaine offers the advantage of reduced motor blockade in the postoperative period compared to bupivacaine.
Abstract:
We compared in a randomized double-blind study, the postoperative analgesia and degree of motor block produced by the new local anaesthetic ropivacaine, with bupivacaine, for caudal anaesthesia in children. Eighty children, 2-5-years-old, ASA I, received one of two local anaesthetics; either ropivacaine 0.25% (1.0 ml x kg(-1)) or bupivacaine 0.25% (1.0 ml x kg(-1)). They were sedated with a continuous infusion of propofol (200 microg x kg(-1) min(-1). The lungs were ventilated with a mixture of 50% nitrous oxide with oxygen. 60 min after local anaesthetic injection, and every 60 min, the extent of the motor block in the recovery room was scored as 1-3, according to a modified Bromage scale. Adverse events and the time to the first analgesic requirement were reported. Patients in the two groups did not differ with respect to age, weight and height. There were no differences in heart rate and arterial pressure between the two groups(P>0.05). No adverse events were observed. The ropivacaine group showed a shorter duration of motor block than the bupivacaine group (P<0.05). The first postoperative analgesic requirement was a mean (sd) of 5 h+/-4.32 after the operation in the ropivacaine group and 5 h+/-3.81 for the bupivacaine group. These findings suggest that caudal anaesthesia with ropivacaine 0.25% in paediatric patients can be effective, with less motor blockade in the postoperative period.