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PEDIATRIC ANESTHESIA

Isobaric Ropivacaine 5 mg/mL for Spinal Anesthesia in Children

Department of Anesthesiology and Intensive Care, Department of Surgery, Kuopio University Hospital, Department of Pharmacology and Toxicology, University of Kuopio, Kuopio, Finland.

Address correspondence and reprint requests to Hannu Kokki, MD, PhD, Department of Anesthesiology and Intensive Care, Kuopio University Hospital, PO Box 1777, FI-70211 Kuopio, Finland. Address e-mail to hannu.kokki{at}kuh.fi

In this clinical trial, we evaluated the clinical effects of ropivacaine for spinal anesthesia in children. An open, prospective study was performed on 93 children, aged 1–17 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of ropivacaine 5 mg/mL at a dose of 0.5 mg/kg body weight (up to 20 mg) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Satisfactory surgical anesthesia was achieved in 92 of the 93 children. Three children received general anesthesia; in one child spinal anesthesia failed, and in two cases surgery outlasted the duration of the sensory block. Four children received supplemental analgesia for skin incision. The mean highest level of sensory block was T6 (range, T2 to T12), and the mean time to the regression of sensory block to T10 was 96 min (range, 34–210 min). One child developed transient bradycardia and one hypotension. After discharge four children developed mild transient radiating neurologic symptoms and one epidural blood patch was performed for persistent position-dependent headache. We conclude that the block performance of intrathecal isobaric ropivacaine in children (>1 yr) is similar to that obtained in adults but the safety of the larger dose used in children warrants further studies.

IMPLICATIONS: This study showed that spinal ropivacaine at a dose of 0.5 mg/kg (maximum dose 20 mg) is an appropriate anesthetic for children aged 1–17 yr for surgery below the umbilicus with duration of <90 min.

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