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PEDIATRIC ANESTHESIA

A Comparison of Three Different Concentrations of Levobupivacaine for Caudal Block in Children

Giorgio Ivani, MD^*, Pasquale De Negri, MD, Per-Arne Lonnqvist, PhD, Staffan Eksborg, PhD, Valeria Mossetti, MD^*, Roberto Grossetti, MD^*, Simona Italiano, MD^*, Franca Rosso, MD^*, Federica Tonetti, MD^*, and Luigi Codipietro, MD^*

*Department of Anesthesiology and Intensive Care Unit, Regina Margherita Children’s Hospital, Turin; Department of Anesthesiology, Intensive Care Unit, and Pain Management, "CROB" Cancer Center, Rionero in Vulture, Italy; Department of Paediatric Anaesthesia and Intensive Care, Astrid Lindgrens Children’s Hospital, Karolinska Hospital; and Karolinska Pharmacy and Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden

Address correspondence and reprint requests to Giorgio Ivani, Chairman, Department of Anesthesiology and Intensive Care, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy. Address e-mail to gioivani{at}libero.it

We investigated three different concentrations of levobupivacaine (0.125%, 0.20%, and 0.25%; n = 20 in each group) for caudal blockade in a prospective, randomized, observer-blinded fashion in children (1–7 yr) undergoing subumbilical surgery. The duration of postoperative analgesia was assessed as the time to first administration of supplemental analgesia (based on a Childrens and Infants Postoperative Pain Scale score of 4), and the degree of immediate postoperative motor blockade was determined by use of a 3-point scale. A dose-response relationship was observed both with regard to median duration of postoperative analgesia (0.125%, 60 min; 0.20%, 118 min; 0.25%, 158 min) and the number of patients with evidence of early postoperative motor blockade (0.125%, 0; 0.20%, 4; 0.25%, 8). The 0.125% concentration was associated with significantly less early motor blockade (P = 0.003) but was found to result in a significantly shorter duration of postoperative analgesia (P < 0.05). Based on these results, the use of 0.20% levobupivacaine might represent the best clinical option if a plain levobupivacaine solution is to be used for caudal blockade in children.

IMPLICATIONS: The use of 0.125% levobupivacaine for caudal blockade (1 mL/kg) in children (1–7 yr) was associated with less early postoperative motor blockade but a shorter duration of postoperative analgesia compared with 0.20% and 0.25% solutions.

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