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PEDIATRIC ANESTHESIA

A Comparison of Epidural Bupivacaine, Levobupivacaine, and Ropivacaine on Postoperative Analgesia and Motor Blockade

Pasquale De Negri, MD^*, Giorgio Ivani, MD, Tiziana Tirri, MD^*, Pasqualina Modano, MD^*, Cesare Reato, MD^*, Staffan Eksborg, PhD, and Per-Arne Lonnqvist, MD PhD

*Department of Anesthesia, ICU and Pain Management, Centro di Riferimento Oncologico della Basilicata-Cancer Center, Rionero in Vulture, Potenza, Italy; Department of Pediatric Anesthesia and Intensive Care Unit, "Regina Margherita" Children’s Hospital, Turin, Italy; and Department of Women and Child Health and Department of Surgical Sciences, Karolinska Institute, Stockholm, Sweden

Address correspondence to Pasquale De Negri, MD, Department of Anesthesia, ICU and Pain Management, CROB-Cancer Center, Strada Provinciale del Vulture 8, Rionero in Vulture (PZ), 85028, Italy. Address e-mail to pdenegri{at}crob.it Reprints will not be available from the authors.

In this prospective, randomized, observer-blinded clinical trial, we compared the incidence of unwanted lower extremity motor blockade and the analgesic efficacy between small-dose (0.125%; 0.2 mg · kg^–1 · h^–1) postoperative epidural infusions of bupivacaine (Group B; n = 28), levobupivacaine (Group L; n = 27), and ropivacaine (Group R; n = 26) in children after hypospadias repair. Motor blockade and pain were assessed at predetermined time points during 48 h by using a modified Bromage scale and the Children’s and Infant’s Postoperative Pain Scale (CHIPPS). Postoperative analgesia was almost identical in all three study groups (CHIPPS range, 0–3), with no need for the administration of supplemental analgesia in any patient. However, significantly more patients in Group B (n = 6; P = 0.03) displayed signs of unwanted motor blockade during the observation period compared with Group L (n = 0) and Group R (n = 0). In conclusion, significantly less unwanted motor blockade was associated with postoperative epidural infusions of 0.125% levobupivacaine or ropivacaine in children after hypospadias repair as compared with a similar infusion of bupivacaine. However, no difference with regard to postoperative analgesia could be detected among the three different local anesthetics studied.

IMPLICATIONS: The use of the newer local anesthetics levobupivacaine and ropivacaine was associated with similar postoperative analgesia but less unwanted muscle weakness of the lower extremities compared with the previous standard (bupivacaine) when administered as small-concentration (0.125%; 0.2 mg · kg^–1 · h^–1) postoperative epidural infusions in children.

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				P.-A. Lonnqvist and N. S. Morton Postoperative analgesia in infants and children Br. J. Anaesth., July 1, 2005; 95(1): 59 - 68. [Full Text] [PDF]