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LETTERS TO THE EDITOR

A More Dilute Concentration of Bupivacaine in a Larger Volume Can Be Effective in Blocking Spermatic Cord Traction Response in Orchidopexy

University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR

To the Editor:

I read with interest the article by Verghese et al. (1). I would like to draw the authors’ attention to two reports that suggest that a more dilute concentration of bupivacaine in a larger volume can be effective to consistently give a higher level of block. The study by Gunter et al. (2) showed that a concentration of 0.175% bupivacaine was as effective as 0.25% but with less effect on the legs. Spears (3), who studied the volume needed to consistently reach thoracic levels in children, found optimum level to be 1.6 mL/kg. This combination of concentration and volume permits good analgesia not only for lower abdominal procedures, but also for upper abdominal and lower thoracic procedures as well, with little effect on lower limbs.

References

1. Verghese ST, Hannallah RS, Rice LJ, et al. Caudal anesthesia in children: effect of volume versus concentration of buspivacine on blocking spermatic cord traction response during orchidopexy. Anesth Analg 2002; 95: 1219–23.[Abstract/Free Full Text]
2. Gunter JB, Dunn CN, Bennie JB, et al. Optimum concentration of bupivacaine for combined caudal-general anesthesia in children. Anesthesiology 1991; 75: 57–61.[Web of Science][Medline]
3. Spears R. Dose-response in infants receiving caudal anaesthesia with bupivacaine. Paediatr Anaesth 1991; 1: 47–52.

Response

Department of Anesthesiology, Children’s National Medical Center, Washington, D.C.

In Response:

We thank Dr. Mayhew for his comments. There are several formulas for determining the appropriate dose of caudal anesthesia in children. When a large volume of bupivacaine is used, Armitage (1) suggested using a 0.2% concentration to prevent the unpleasant sensation of lower limb weakness. We agree that larger volumes of more dilute solutions of bupivacaine can be used to achieve analgesia for upper abdominal and lower thoracic procedures.

Reference

1. Armitage EN. Caudal block in children. Anaesthesia 1979; 34; 396.

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