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Ropivacaine and bupivacaine for long-term epidural infusion in a small child
B Gustorff1, P Lierz, P Felleiter
1Department of Anaesthesiology and General Intensive Care (B), University of Vienna, Austria. burkhard.gustorff@univie.ac.at
Insights
This case study explores long-term epidural anesthesia in a pediatric patient using ropivacaine. While effective and safe in this instance, potentially toxic doses necessitate cautious use in pediatric anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pain Management
Background:
- Limited data exists on the long-term use of ropivacaine in pediatric anesthesia.
- Ropivacaine is generally considered less toxic than bupivacaine.
Observation:
- A 21-month-old girl received long-term epidural anesthesia for vaginal brachytherapy over two 3-day periods.
- 0.5% bupivacaine and 0.5% or 0.75% ropivacaine were administered.
- Mean doses of bupivacaine ranged from 1.05 to 1.32 mg kg-1 h-1.
- Mean doses of ropivacaine ranged from 1.40 to 3.86 mg kg-1 h-1.
Findings:
- No toxic side effects were observed during the administration of either epidural ropivacaine or bupivacaine.
- Both agents were effective in providing anesthesia for the procedure.
- The administered doses of ropivacaine, particularly at higher concentrations, were potentially toxic.
Implications:
- Epidural ropivacaine can be considered for long-term pediatric anesthesia in specific cases.
- Extreme caution is advised due to potentially toxic doses.
- Further research is needed to establish safe and effective dosing guidelines for long-term pediatric epidural ropivacaine use.
Abstract:
Ropivacaine is assumed to be less toxic than bupivacaine but there are no reports concerning its long-term use in paediatric anaesthesia. We report the use of ropivacaine for long-term epidural anaesthesia in a 21-month-old girl. In two consecutive periods of 3 days each, 0.5% bupivacaine and 0.5% or 0.75% ropivacaine were administered to facilitate painful vaginal brachytherapy. The mean dose of bupivacaine increased from 1.05 to 1.32 mg kg-1 h-1 and that of ropivacaine increased from 1.40 to 3.86 mg kg-1 h-1. No toxic side effects were observed. We conclude that both epidural ropivacaine and bupivacaine were effective and safe during long-term epidural anaesthesia in this particular case. However, the doses were potentially toxic and should therefore be used with extreme caution.