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Anesth Analg 2002;94:259-265
© 2002 International Anesthesia Research Society

PEDIATRIC ANESTHESIA

Ropivacaine Undergoes Slower Systemic Absorption from the Caudal Epidural Space in Children than Bupivacaine

Manoj K. Karmakar, FRCA*, Cindy S. T. Aun, MD*, Eliza L. Y. Wong, MPH*, April S. Y. Wong, BSc*, Simon K. C. Chan, FANZCA*, and Chung K. Yeung, MD{dagger}

*Department of Anesthesia and Intensive Care and {dagger}Department of Surgery, Pediatric Surgical Division, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong

Address correspondence and reprint requests to Manoj K. Karmakar, FRCA, Associate Professor, The Chinese University of Hong Kong, Department of Anesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Address e-mail to karmakar{at}cuhk.edu.hk

We compared the systemic absorption of ropivacaine and bupivacaine after caudal epidural administration in children. Twenty ASA physical status I or II children aged 1–7 yr undergoing elective hypospadias repair were randomized after the induction of general anesthesia to receive a single caudal epidural injection of 2 mg/kg of either ropivacaine 0.2% (R) or bupivacaine 0.2% (B) in a double-blinded fashion. Peripheral venous blood samples (1 mL) were obtained before and 1, 5, 10, 15, 20, 30, 40, 50, 60, 70, 80, 90, and 120 min after the caudal injection. The total R and B concentration was measured in plasma by using high-performance liquid chromatography. All blocks were successful, and there were no complications. The peak plasma concentration (mean ± SD) (R = 0.67 ± 0.16 and B = 0.73 ± 0.23 µg/mL) and the area under the plasma concentration curve (R = 61.9 ± 20.6 and B = 62.7 ± 18.2 µg · mL-1 · min-1) were comparable between the two study groups. The median (range) time to attain peak plasma concentration was significantly slower in children who received ropivacaine (R = 65 [10–120] min and B = 20 [15–50] min, P < 0.05). We conclude that ropivacaine undergoes slower systemic absorption from the caudal epidural space in children than does bupivacaine.

IMPLICATIONS: We compared the systemic absorption of ropivacaine (0.2%) and bupivacaine (0.2%) after caudal epidural injection of 2 mg/kg in children aged 1–7 yr. Our results show that ropivacaine undergoes slower systemic absorption from the caudal epidural space in children than does bupivacaine.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2002 by the International Anesthesia Research Society.