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Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with

Elisabeth F A Dobereiner1, Robin G Cox, Alastair Ewen

  • 1Department of Anesthesiology, Alberta Children's Hospital, University of Calgary, AB, Canada.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|September 17, 2010
PubMed

Insights

For pediatric caudal anesthesia, bupivacaine, ropivacaine, and levobupivacaine offer similar efficacy. Ropivacaine minimizes motor block, while bupivacaine provides it, with rare adverse effects across all agents.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Pharmacology

Background:

  • Selecting long-acting local anesthetics for pediatric caudal anesthesia is crucial.
  • Bupivacaine, ropivacaine, and levobupivacaine are commonly used agents.

Purpose of the Study:

  • To identify the best evidence for choosing between bupivacaine, ropivacaine, and levobupivacaine for single-shot pediatric caudal anesthesia.

Main Methods:

  • A systematic literature search was performed on PubMed and Medline (OVID).
  • Included were randomized controlled trials (RCTs) and meta-analyses in children (0-18 years) comparing at least two of the three agents.
  • Data on clinical efficacy and side effects were extracted and analyzed using Centre for Evidence-Based Medicine criteria.

Main Results:

  • All three agents demonstrated equivalent clinical efficacy in pediatric caudal anesthesia.
  • Bupivacaine showed the highest incidence of motor block, while ropivacaine had the lowest.
  • Adverse effects were infrequent, mild, and not drug-dependent; no serious adverse events were reported in human studies.

Conclusions:

  • No single agent is superior in efficacy for pediatric caudal anesthesia.
  • Bupivacaine is recommended when motor block is desired; ropivacaine is preferred for minimizing motor block.
  • While human studies show rare and mild adverse effects, animal studies suggest a potentially safer profile for ropivacaine or levobupivacaine compared to bupivacaine.
Abstract

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