51. The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions
- Author
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Bruno Guido Locatelli, Geoff Frawley, Moreno Favarato, Angelica Spotti, Graham Knottenbelt, Roberto Fumagalli, Pablo Ingelmo, Ingelmo, P, Locatelli, B, Frawley, G, Knottenbelt, G, Favarato, M, Spotti, A, and Fumagalli, R
- Subjects
Anesthesia, Epidural ,Male ,medicine.medical_specialty ,medicine.drug_class ,levobupivacaine ,Pediatrics ,Lumbar ,Bolus (medicine) ,Double-Blind Method ,Anesthesiology ,medicine ,Humans ,Anesthetics, Local ,Epidural administration ,epidural anesthesia ,MED/41 - ANESTESIOLOGIA ,Bupivacaine ,Pain, Postoperative ,Dose-Response Relationship, Drug ,Ropivacaine ,Local anesthetic ,business.industry ,bupivacaine ,Infant ,Surgery ,Anesthesiology and Pain Medicine ,Levobupivacaine ,Child, Preschool ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Female ,business ,medicine.drug - Abstract
Summary Background: There is no consensus on the concentration or type of local anesthetic used for initiation of epidural anesthesia. The aim of this randomized, double-blind, controlled trial was to compare the clinical effectiveness of epidural administration of both levobupivacaine and bupivacaine in 0.2% and 0.25% concentrations in pediatric patients undergoing abdominal and urological surgery. Methods: One hundred and forty-one children scheduled for lower abdominal and urological surgery were randomized to receive 0.4–0.6 ml·kg−1 epidural, 0.25% bupivacaine, 0.2% bupivacaine, 0.25% levobupivacaine or 0.2% levobupivacaine. Initial epidural volumes, onset times; hemodynamic consequences, postoperative pain scores and degree of residual postoperative motor block were all recorded. Results: There were no significant differences in the proportion of children with effective analgesia after incision [0.20% bupivacaine 97%, 0.25% bupivacaine 94%, 0.20% levobupivacaine 91%, 0.25% levobupivacaine 92% (P = 0.73)] when a median volume of 0.55 ml·kg−1 was used. There was no association between the volume used for thoracic, lumbar, or sacral epidural anesthesia and the effectiveness of the agents used. There was a significantly greater incidence of pain on awakening with the 0.2% solutions compared with the 0.25% solutions, but no differences in the incidence of residual motor block between groups. Conclusions: While there is no difference in the proportion of effective surgical anesthesia, the lower incidence of pain and distress with the 0.25% solutions suggests that this concentration has clinical advantages over the 0.2% solutions for pediatric epidural anesthesia.
- Published
- 2007