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Comparison of ropivacaine with bupivacaine for paediatric caudal block
G Ivani1, E Lampugnani, M Torre
1Department of Anaesthesia, Gaslini Children's Hospital, Genoa, Italy.
Insights
Ropivacaine and bupivacaine provide effective caudal analgesia in children undergoing minor surgery. Both anesthetics demonstrated similar onset times and duration of pain relief, with no significant motor block observed.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Caudal extradural injection is a common technique for pediatric analgesia.
- Bupivacaine is a widely used local anesthetic, but concerns exist regarding its cardiotoxicity.
- Ropivacaine, a newer anesthetic, offers a potentially safer profile with similar efficacy.
Purpose of the Study:
- To compare the efficacy and safety of caudal ropivacaine versus bupivacaine in children undergoing elective minor surgery.
- To evaluate onset time, duration of analgesia, and incidence of motor block.
Main Methods:
- A double-blind, multicenter study involving 245 children aged 1-10 years.
- Random allocation to receive either 0.25% bupivacaine or 0.2% ropivacaine via caudal extradural injection.
- Standardized general anesthesia and monitoring throughout the procedure.
Main Results:
- Similar onset times for both ropivacaine (9.7 min) and bupivacaine (10.4 min).
- 40% of children did not require further analgesia post-operatively.
- Mean time to first analgesia was 233 min for bupivacaine and 271 min for ropivacaine.
- No measurable motor block was observed in either group.
Conclusions:
- Ropivacaine 2 mg kg-1 is as effective as bupivacaine 2.5 mg kg-1 for caudal analgesia in pediatric patients.
- Both agents provide prolonged postoperative pain relief with a favorable safety profile.
- Ropivacaine represents a viable alternative to bupivacaine for caudal anesthesia in children.
Abstract:
In a double-blind, multicentre study 245 children aged 1-10 yr undergoing elective minor surgery as inpatients were randomly allocated to receive a single caudal extradural injection of 1 ml kg-1 of either 0.25% bupivacaine or 0.2% ropivacaine after induction of light general anaesthesia. The groups were comparable for age, weight, vital signs and duration of surgery. The onset time was similar for ropivacaine and bupivacaine (9.7 vs 10.4 min). Further analgesia was not required in 40% of children. The mean time to first analgesia in the remainder was 233 min in the bupivacaine group and 271 min in the ropivacaine group. No motor block was measurable in either group. Ropivacaine 2 mg kg-1 was as effective as bupivacaine 2.5 mg kg-1 for caudal analgesia in children.