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Bhati K, Saini N, Aeron N, Dhawan S. A Comparative Study to Evaluate the Efficacy of Dexmedetomidine and Clonidine to Accentuate the Perioperative Analgesia of Caudal 0.25% Isobaric Levobupivacaine in Pediatric Infraumbilical Surgeries. Cureus 2022; 14:e27825. [PMID: 36106237 PMCID: PMC9455914 DOI: 10.7759/cureus.27825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/05/2022] Open
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Reddy A, Bhandary A, Shetty SR, Harish BG. Comparative study between an ultrasound-guided transversus abdominis plane block and an ultrasound-guided caudal block for postoperative analgesia in children undergoing lower abdominal surgeries – a prospective randomised study. Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.5.2489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Reddy
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
| | - A Bhandary
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
| | - SR Shetty
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
| | - BG Harish
- Department of Anaesthesiology, K.S. Hegde Medical Academy, NITTE (Deemed to be University),
India
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Chandrakant P, Vinod Kumar V, Arvind K, Neeraj K, Gunjan K. A Prospective Double-Blind Comparative Clinical Study Between Caudal Levobupivacaine (0.125%) with Clonidine and Ropivacaine (0.125%) with Clonidine on Post-Operative Analgesia in Paediatric Patients Undergoing Infra-Umbilical Surgery. Rom J Anaesth Intensive Care 2020; 27:52-7. [PMID: 34056125 DOI: 10.2478/rjaic-2020-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Caudal epidural block is a reliable technique in paediatric patients but associated with various complications especially with higher concentration of drugs. We proposed a comparative study between levobupivacaine and ropivacaine at low concentration (0.125%) with clonidine at low dose (1 mcg/kg) taken as adjuvant. We aimed to see duration of post-operative analgesia, degree of motor blockade and other associated complications. Materials and Methods Eighty paediatric patients (1-6 years), American society of anaesthesiologists grade I and II, undergoing infra-umbilical surgery under general anaesthesia were randomly allocated into two groups of 40 each. Group A patients were given caudal levobupivacaine (0.125%) and Group B patients were given caudal ropivacaine (0.125%). Clonidine (1 mcg/kg) was taken as adjuvant in both the groups. Post-operative pain, sedation and motor blockade were assessed at 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours, 18 hours and 24 hours using Observational Pain Scale, modified Bromage Scale and four-point sedation score, respectively. Any other complications were also noted. Results Motor blockade was not associated with any of the patients. Duration of post-operative sedation was similar in both the groups. Duration of post-operative analgesia was significantly higher in Group A (p < 0.0001). Adverse effects and complications were negligible in both the groups. Conclusion Both levobupivacaine and ropivacaine can be used safely at low concentration (0.125%) taking clonidine at low dose (1 mcg/kg) as adjuvant in paediatric caudal epidural block without significant motor blockade and other complications, duration of post-operative analgesia being significantly higher in the levobupivacaine group.
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Wang HZ, Wang LY, Liang HH, Fan YT, Song XR, She YJ. Effect of caudal ketamine on minimum local anesthetic concentration of ropivacaine in children: a prospective randomized trial. BMC Anesthesiol 2020; 20:144. [PMID: 32513111 PMCID: PMC7278144 DOI: 10.1186/s12871-020-01058-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 05/27/2020] [Indexed: 12/31/2022] Open
Abstract
Background Caudal ketamine has been shown to provide an effective and prolonged post-operative analgesia with few adverse effects. However, the effect of caudal ketamine on the minimum local anesthetic concentration (MLAC) of ropivacaine for intra-operative analgesia is unclear. Methods One hundred and sixty-nine children were randomized to five groups: Group C (caudal ropivacaine only), Group K0.25 (caudal ropivacaine plus 0.25 mg/kg ketamine), Group K0.5 (caudal ropivacaine plus 0.5 mg/kg ketamine), Group K0.75 (caudal ropivacaine plus 0.75 mg/kg ketamine), and Group K1.0 (caudal ropivacaine plus 1.0 mg/kg ketamine). The primary outcome was the MLAC values of ropivacaine with/without ketamine for caudal block. Results The MLAC values of ropivacaine were 0.128% (0.028%) in the control group, 0.112% (0.021%) in Group K0.25, 0.112% (0.018%) in Group K0.5, 0.110% (0.019%) in Group K0.75, and 0.110% (0.020%) in Group K1.0. There were no significant differences among the five groups for the MLAC values (p = 0.11). During the post-operative period the mean durations of analgesia were 270, 381, 430, 494, and 591 min in the control, K0.25, K0. 5, K0.75, and K1.0 groups respectively, which shown that control group is significantly different from all ketamine groups. Also there were significant differences between K0.25 and K0.75 groups, and between K1.0 groups and the other ketamine groups. Conclusions Adding caudal ketamine to ropivacaine prolong the duration of post-operative analgesia; however, it does not decrease the MLAC of caudal ropivacaine for intra-operative analgesia in children. Clinical trial registration ChiCTR-TRC-13003492. Registered on 13 August 2013.
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Affiliation(s)
- Huai-Zhen Wang
- Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Ling-Yu Wang
- Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Hui-Hong Liang
- Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Yan-Ting Fan
- Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Xing-Rong Song
- Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China
| | - Ying-Jun She
- Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China.
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Prabhu JP, Prakash J, Kharwar R, Priye S, Singh D, Saran K. Comparison of epidural levobupivacaine and bupivacaine in lower abdominal and lower limb surgeries. Bali J Anaesthesiol 2020. [DOI: 10.4103/bjoa.bjoa_21_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abd Ellatif S, Ahmed F. Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in children undergoing laparoscopic appendectomy: a randomized controlled study. ACTA ACUST UNITED AC 2020. [DOI: 10.4103/roaic.roaic_72_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma J, Gupta R, Kumari A, Mahajan L, Singh J. A Comparative Study of 0.25% Levobupivacaine, 0.25% Ropivacaine, and 0.25% Bupivacaine in Paediatric Single Shot Caudal Block. Anesthesiol Res Pract 2018; 2018:1486261. [PMID: 30515207 DOI: 10.1155/2018/1486261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/27/2018] [Indexed: 11/17/2022] Open
Abstract
Aim There are limited data comparing levobupivacaine, ropivacaine, and bupivacaine in paediatric patients. So, this study was performed to evaluate the caudal effectiveness of all the three drugs in paediatric patients undergoing infraumbilical surgeries and associated complications with these drugs. Material and Methods 90 patients of ASA grade I and II posted for elective infraumbilical surgeries were randomly divided into three groups of 30 each. A standardized anaesthetic protocol was used. Patients received 0.25% levobupivacaine in group 1, 0.25% ropivacaine in group 2, and 0.25% bupivacaine in group 3. The effectiveness of block was assessed using caudal effectiveness score. Postoperative pain relief was assessed with modified Hannallah pain score. Haemodynamic parameter monitoring was done. The duration of analgesia and associated complications were studied. Statistical analysis was done using the chi-square test for nonparametric data. Parametric data were analysed using ANOVA for intergroup comparison and Tukey's HSD for intragroup comparison. Results Demographic data were comparable. Haemodynamic parameters remained within normal range. Mean caudal effectiveness score in all the three groups was statistically insignificant (p > 0.05). The duration of analgesia provided by bupivacaine (145.31 ± 26.17 min) was longer than levobupivacaine (126.15 ± 15.15 min) and ropivacaine (114.68 ± 11.32 min) (p < 0.01). Mean postoperative pain scores were lower in group 3 as compared to group 1 and group 2. Conclusion We conclude that levobupivacaine and ropivacaine provide similar intraoperative quality with minimal haemodynamic variability and shorter duration of postoperative analgesia without any significant complications when compared with racemic bupivacaine. This trial is registered with CTRI/2018/03/012402.
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El-Sharkawy M, Dowidar AER, Amen S, El-Kalla R. Efficacy of caudal levopubivacaine versus bupivacaine in children undergoing lower abdominal surgery: a prospective randomized controlled study. Tanta Med J 2018; 46:1. [DOI: 10.4103/tmj.tmj_58_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Gadre SK, Minai OA, Wang XF, Zhang Q, Budev M, Tonelli AR. Lung or Heart-Lung Transplant in Pulmonary Arterial Hypertension: What Is the Impact of Systemic Sclerosis? EXP CLIN TRANSPLANT 2017; 15:676-684. [PMID: 28540841 DOI: 10.6002/ect.2016.0209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Little is known about recipient characteristics and outcomes of patients with pulmonary arterial hypertension undergoing lung transplant, particularly those with systemic sclerosis-associated disease. Here, we describe the characteristics and outcomes of patients with pulmonary arterial hypertension undergoing lung transplant, focusing on systemic sclerosis-associated disease. MATERIALS AND METHODS This retrospective study included pulmonary arterial hypertension patients undergoing lung or heart-lung transplant between July 1992 and August 2013 at a single center. RESULTS We evaluated 51 patients with pulmonary arterial hypertension (37.3% males; mean age of 45.3 ± 11.9 y). Of 51 patients, 9 (17.6%) had systemic sclerosis-associated pulmonary arterial hypertension. Pulmonary arterial hypertension patients without systemic sclerosis-associated disease had higher mean pulmonary arterial pressure (P = .002), higher pulmonary vascular resistance (P = .008), and were more likely to have severe right ventricular systolic dysfunction (P = .006) than individuals with the disease. Mean hospital stay posttransplant was similar in the 2 groups (42.2 ± 43.3 vs 43.1 ± 19.4 d; P = .20). Higher pretransplant creatinine clearance (P = .0005), forced vital capacity (P = .01), and absence of vasopressor/inotrope use (P = .03) were associated with shorter hospital stay. Mortality for pulmonary arterial hypertension patients with versus without systemic sclerosis-associated disease was 0% versus 13% at 1 year, 29% versus 24% at 2 years, and 86% versus 53% at 5 years. Female sex (hazard ratio, 0.23; 95% confidence interval, 0.08-0.68) and less severe tricuspid regurgitation (hazard ratio, 0.31; 95% confidence interval, 0.11-0.89) were independently associated with long-term survival. CONCLUSIONS Pulmonary arterial hypertension patients with versus without systemic sclerosis-associated disease have comparable short-term and 2-year outcomes after lung or heart-lung transplant. Female sex and less severe tricuspid regurgitation were independently associated with better long-term survival. These outcomes did not vary when adjusted for the year of transplant.
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Affiliation(s)
- Shruti K Gadre
- From the Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kendigelen P, Tutuncu AC, Emre S, Altindas F, Kaya G. Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery: A Randomized Controlled Trial. Reg Anesth Pain Med 2016; 41:610-5. [PMID: 27501015 DOI: 10.1097/AAP.0000000000000447] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Postoperative pain management after hypospadias surgery is often challenging. Caudal block is used for analgesia but has limitations. This study compares the analgesic efficiency of pudendal block with that of caudal block in pediatric patients undergoing hypospadias repair surgery. METHODS This prospective, double-blind, randomized, controlled study enrolled 84 patients receiving pudendal block or caudal block before hypospadias surgery. In the pudendal group, the pudendal nerve was identified using a nerve stimulator, and the block consisted of 0.25% bupivacaine 0.5 mL/kg. In the caudal group, the caudal block used 0.2% bupivacaine 1 mL/kg. Our primary outcome was pain intensity within 24 hours postoperatively. The trial was registered at ClinicalTrials.gov (number: NCT02390388). RESULTS For the primary outcome, patients in the pudendal group had lower postoperative pain intensity when compared with the caudal group (P < 0.001). Three patients in the pudendal group and all of the patients in the caudal group needed additional analgesia within 24 hours after the surgery (P < 0.001). The family satisfaction rate was significantly higher in the pudendal group (P < 0.001). CONCLUSIONS For the pudendal group, the pain scores for the first 24 hours after the surgery were significantly lower and the duration of analgesia was longer.
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Altaş C, Küçükosman G, Yurtlu BS, Okyay RD, Aydın BG, Pişkin Ö, Çimencan M, Ayoğlu H, Hancı V, Özkoçak-Turan I. Anesthesia methods used by anesthetic specialists for circumcision cases. National survey study for Turkey. Saudi Med J 2017; 38:75-81. [PMID: 28042634 PMCID: PMC5278069 DOI: 10.15537/smj.2017.1.15632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives: To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision.
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Affiliation(s)
- Cafer Altaş
- Department of Anesthesiology and Reanimation, Sakarya Education and Research Hospital, Sakarya, Turkey. E-mail.
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Praveen P, Remadevi R, Pratheeba N. Caudal Epidural Analgesia in Pediatric Patients: Comparison of 0.25% Levobupivacaine and 0.25% Ropivacaine in Terms of Motor Blockade and Postoperative Analgesia. Anesth Essays Res 2017; 11:223-227. [PMID: 28298789 PMCID: PMC5341641 DOI: 10.4103/0259-1162.200231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
CONTEXT Ropivacaine and Levo-Bupivacaine have been safely used for caudal anaesthesia in children, but there are limited studies comparing the efficacy of 0.25% Ropivacaine and 0.25% Levo-Bupivacaine for caudal anaesthesia in infraumbilical surgeries. AIMS The aim of this study was to compare the incidence of motor blockade and postoperative analgesia with 0.25% ropivacaine and 0.25% levobupivacaine for the caudal block in children receiving infraumbilical surgery. SETTINGS AND DESIGN This was a randomized double-blinded study. SUBJECTS AND METHODS Sixty patients of either sex, between 1 and 10 years posted for elective infraumbilical surgeries, to receive caudal block with either (Group R) ropivacaine 0.25% or (Group L) levobupivacaine 0.25% of volume 1 ml/kg were included in the study. Motor blockade was assessed using motor power scale, and pain was assessed every 1 h for first 6 h, then 2nd hourly for following 18 h using modified Hannallah objective pain scale. If pain score is ≥4, the patients were given paracetamol suppositories 20 mg/kg as rescue analgesia. STATISTICAL ANALYSIS USED All analyses were performed using Chi-square test, Student's independent t-test, Kruskal-Wallis test, Mann-Whitney U-test. RESULTS The time for full motor recovery was similar in both groups; in Group R, ropivacaine: 180.50 ± 14.68 min, and in Group L, levobupivacaine: 184.50 ± 18.02 min, with P = 0.163. The duration of postoperative pain relief between the groups was 330.50 ± 9.54 min in Group L (levobupivacaine) and 312.67 ± 5.56 min in Group R (ropivacaine) with P = 0.165 not statistically significant. CONCLUSIONS Both ropivacaine 0.25% and levobupivacaine 0.25% have similar recovery from motor blockade and postoperative analgesia.
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Affiliation(s)
- P. Praveen
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - R. Remadevi
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - N. Pratheeba
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
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Marjanovic V, Budic I, Stevic M, Simic D. A Comparison of Three Different Volumes of Levobupivacaine for Caudal Block in Children Undergoing Orchidopexy and Inguinal Hernia Repair. Med Princ Pract 2017; 26:331-336. [PMID: 28437787 PMCID: PMC5768116 DOI: 10.1159/000475936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/22/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of 3 different volumes of 0.25% levobupivacaine caudally administered on the effect of intra- and postoperative analgesia in children undergoing orchidopexy and inguinal hernia repair. SUBJECTS AND METHODS Forty children, aged 1-7 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomized into 3 different groups according to the applied volumes of 0.25% levobupivacaine: group 1 (n = 13): 0.6 mL∙kg-1; group 2 (n = 10): 0.8 mL∙kg-1; and group 3 (n = 17): 1.0 mL∙kg-1. The age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were compared among the groups. The time to first use of the analgesic and the number of patients who required analgesic 24 h after surgery in the time intervals within 6 h, between 6 and 12 h, and between 12 and 24 h postoperatively were evaluated among the groups. Statistical analyses were performed with a Dunnett t test, ANOVA, or Kruskal-Wallis test and χ2 test. Logistic regression analysis was used in order to examine predictive factors on duration of postoperative analgesia. RESULTS Age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were similar among the groups. The time to first analgesic use did not differ among the groups, and logistic regression modelling showed that using the 3 different volumes of levobupivacaine had no predictive influence on duration of postoperative analgesia. The numbers of patients who required analgesics within 6 h (3/2/3), between 6 and 12 h (3/1/3), and between 12 and 24 h (1/0/2) after surgery were similar among the groups. CONCLUSION The 3 different volumes of 0.25% levobupivacaine provided the same quality of intra- and postoperative pain relief in pediatric patients undergoing orchidopexy and inguinal hernia repair.
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Affiliation(s)
- Vesna Marjanovic
- Center for Anesthesia and Resuscitation, Clinical Centre Nis, Nis, Serbia
- *Vesna Marjanovic, Center for Anesthesia and Resuscitation, Clinical Centre Nis, Bul. Zorana Djindjica 48, RS-18000 Nis (Serbia), E-Mail
| | - Ivana Budic
- Center for Anesthesia and Resuscitation, Clinical Centre Nis, Nis, Serbia
- Department of Anesthesiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marija Stevic
- Department of Anesthesia, University Children's Hospital Belgrade, Belgrade, Serbia
| | - Dusica Simic
- Department of Anesthesia, University Children's Hospital Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Saleh RH, Yousef MF, Nassar HM, Younes TF. Effect of nalbuphine as an adjuvant on levobupivacaine induced caudal analgesia in children undergoing surgical procedures, controlled randomized double blinded study. Egyptian Journal of Anaesthesia 2016; 32:97-102. [DOI: 10.1016/j.egja.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sathyanarayana LA, Heggeri VM, Simha PP, Narasimaiah S, Narasimaiah M, Subbarao BK. Comparison of Epidural Bupivacaine, Levobupivacaine and Dexmedetomidine in Patients Undergoing Vascular Surgery. J Clin Diagn Res 2016; 10:UC13-7. [PMID: 26894153 PMCID: PMC4740681 DOI: 10.7860/jcdr/2016/17344.7079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/03/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Levobupivacaine is the s-isomer of racemic Bupivacaine. It is less cardio, neurotoxic and equally potent local anaesthetic compared to its racemate. It is known to cause less Depression of myocardial contractility. Dexmeditomidine when used via epidural route has synergistic effect with local anaesthetics. Majority of patients presenting for vascular surgery are elderly and have associated co-morbidities like diabetes, hypertension, and coronary artery disease. We intend to study safety and efficacy of epidural Levoupivacaine and Dexmedetomidine in this group of patients. MATERIALS AND METHODS Sixty adult patients undergoing lower limb vascular surgery under lumbar epidural anaesthesia were randomly allocated to three groups. All groups were preloaded with 10ml/kg of crystalloid solution. B group was scheduled to receive 15 ml of racemic Bupivacaine, L-group was scheduled to receive 15ml of Levobupivacaine and LD-group received 15ml of Levobupivacaine with 0.5 mics/kg Dexmeditomedine. Time to onset of sensory block to T-10, maximum sensory level achieved, Bromage scale, time to two segment regression, time to total regression, sedation level achieved and patients assessment of quality of anaesthesia were assessed. Haemodynamic parameters were monitored throughout study period. Adverse effects were noted and treated appropriately. RESULTS Baseline parameters were comparable among all the groups. Time to onset of sensory block to T-10 and maximum level of block achieved, was comparable among the groups. Time to two segment regression and time to total regression was significantly prolonged in LD group compared to other two groups. There was significant bradycardia noted in LD group which required treatment. CONCLUSION Levobupivacaine can be safely used in elderly high risk patients undergoing vascular surgery. Addition of dexmedetomidine prolongs the duration of anaesthesia and postoperative analgesia.
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Affiliation(s)
- Lakshmi Adalagere Sathyanarayana
- Assistant Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Vijayakumar M. Heggeri
- Assistant Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Parimala Prasanna Simha
- Associate Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Satish Narasimaiah
- Associate Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Manjunath Narasimaiah
- Professor and Head, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Bharathi Katheraguppa Subbarao
- Assistant Professor, Department of Cardiovascular Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Abdel Hamid H, Abdel Aziz M, Abdelfatah A. Ultrasound-guided caudal analgesia using fentanyl versus dexmedetomidine as an adjuvant for levobupivacaine in infraumbilical pediatric surgeries. Ain-Shams J Anaesthesiol 2016. [DOI: 10.4103/1687-7934.198267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Krishnadas A, Suvarna K, Hema VR, Taznim M. A comparison of ropivacaine, ropivacaine with tramadol and ropivacaine with midazolam for post-operative caudal epidural analgesia. Indian J Anaesth 2016; 60:827-832. [PMID: 27942056 PMCID: PMC5125186 DOI: 10.4103/0019-5049.193672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Caudal epidural analgesia is the most commonly used method of post-operative analgesia in children undergoing subumbilical surgeries. Many additive drugs have been used to prolong the post-operative analgesia. The aim of this study was to compare the efficacy of tramadol or midazolam addition to caudal ropivacaine for post-operative analgesia in children undergoing subumbilical surgeries. METHODS In this prospective, randomised, double-blinded comparative study, sixty children of either gender, in the age group of 1-5 years and scheduled for elective subumbilical surgeries were randomly divided into three groups of twenty each. Children in Group R received an epidural injection of 1 mL/kg of 0.2% plain ropivacaine whereas children in Group RT received an epidural injection of 2 mg/kg of tramadol plus 1 mL/kg of 0.2% ropivacaine and Group RM received an epidural injection of 50 μg/kg midazolam plus 1 mL/kg of 0.2% ropivacaine. The primary outcome variable was the duration of time to rescue analgesia. The secondary outcome variables were motor block, sedation score and urinary retention. Statistical comparison among the three groups was performed using one-way ANOVA with post hoc analysis using Bonferroni. For qualitative variables, Chi-square test was used. Statistical significance was defined as P < 0.05. RESULTS The mean duration of time to rescue analgesia was significantly longer (P < 0.001) in Group RT (913 ± 315.5 min) and Group RM (769.2 ± 331.9 min) compared to Group R (437.75 ± 75.68 min). However, there was no significant difference in the duration of time to rescue analgesia between RT and RM groups. Motor block and sedation scores were comparable between groups. CONCLUSIONS The addition of tramadol or midazolam to caudal epidural ropivacaine prolongs the duration of analgesia without causing significant side effects.
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Affiliation(s)
- A Krishnadas
- Department of Anaesthesia, Government Medical College, Kozhikode, Kerala, India
| | - K Suvarna
- Department of Anaesthesia, Government Medical College, Kozhikode, Kerala, India
| | - V R Hema
- Department of Anaesthesia, Government Medical College, Kozhikode, Kerala, India
| | - M Taznim
- Department of Anaesthesia, Government Medical College, Kozhikode, Kerala, India
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Sengupta S, Mukherji S, Sheet J, Mandal A, Swaika S. Caudal-epidural bupivacaine versus ropivacaine with fentanyl for paediatric postoperative analgesia. Anesth Essays Res 2015; 9:208-12. [PMID: 26417128 PMCID: PMC4563976 DOI: 10.4103/0259-1162.154541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Aims: Caudal-epidural, the most commonly used regional analgesia technique, is virtually free of measurable hemodynamic effects, thus adding a new dimension to the evolving necessity of pediatric postoperative pain management. Though, bupivacaine is the most commonly used drug for this purpose, ropivacaine has emerged as a safer alternative, with the addition of opioids, like fentanyl, increasing the effective duration of analgesia. With this overview, our present study was designed to compare the postoperative analgesic efficacy of bupivacaine-fentanyl and ropivacaine-fentanyl combinations by caudal-epidural technique in pediatric infraumbilical surgeries. Materials and Methods: Totally, 60 pediatric patients, of either sex, aged between 2 and 8 years, American Society of Anesthesiologists physical status I and II, undergoing elective infraumbilical surgeries were assigned into two groups, Group BF receiving bupivacaine 0.25%, 0.7 ml/kg and Group RF receiving ropivacaine 0.25%, 0.7 ml/kg with fentanyl 1 μg/kg added to each group. Assessment of pain was done using “Hannallah pain scale.” Consumption of the total amount of rescue analgesic and time to requirement of the first dose, as also duration of motor blockade were noted. Perioperative hemodynamics and any adverse effects were monitored at regular intervals. Results: The RF Group experienced significantly longer duration of effective postoperative analgesia, with significantly shorter duration of motor blockade and lesser total analgesic requirement in comparison to the BF Group. Hemodynamically, patients in both the groups, were equally stable. Conclusion: Ropivacaine, with an equipotent analgesic efficacy and a lesser duration of motor block, can be used as an alternative to bupivacaine for pediatric postoperative pain care through the caudal route.
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Affiliation(s)
- Swapnadeep Sengupta
- Department of Anaesthesiology and Critical Care, Medical College and Hospital, Kolkata, India
| | - Sudakshina Mukherji
- Department of Anaesthesiology and Critical Care, Medical College and Hospital, Kolkata, India
| | - Jagabandhu Sheet
- Department of Anaesthesiology and Critical Care, IQ City Medical College, Durgapur, India
| | - Anamitra Mandal
- Department of Anaesthesiology and Critical Care, College of Medicine and JNM Hospital, Kalyani, India
| | - Sarbari Swaika
- Department of Anaesthesiology and Critical Care, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
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She Y, Xie G, Tan Y, Kuang X, Yu G, Lian G, Song X. A prospective study comparing the onset and analgesic efficacy of different concentrations of levobupivacaine with/without dexmedetomidine in young children undergoing caudal blockade. J Clin Anesth 2015; 27:17-22. [DOI: 10.1016/j.jclinane.2014.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/10/2014] [Accepted: 09/03/2014] [Indexed: 01/31/2023]
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Chipde S, Banjare M, Arora K, Saraswat M. Prospective randomized controlled comparison of caudal bupivacaine and ropivacaine in pediatric patients. Ann Med Health Sci Res 2014; 4:S115-8. [PMID: 25184076 PMCID: PMC4145506 DOI: 10.4103/2141-9248.138025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Bupivacaine and ropivacaine are commonly used agents for caudal anesthesia in pediatric patients. Several studies have shown different motor and cardiovascular effects of two drugs. Aim: The primary objective of this study was to evaluate the efficacy of both drugs and secondary objective was to compare motor blockade and hemodynamic effects caused by them. Subjects and Methods: This was a prospective randomized controlled study including 50 consecutive patients in the age group of 1-10 years, who underwent urogenital surgeries under general anesthesia. Caudal block was given with either bupivacaine (0.25%) 1 ml/kg (Group I) or ropivacaine (0.25%) 1 ml/kg (Group II). Heart rate (HR) and systolic blood pressure (SBP) were recorded as a baseline, before the anesthesia induction and then at 30, 60 and 90 min after incision. Pain scores were assessed post-operatively by a single observer at 30 min and then at 2, 4, 8 and 12 h with a 5-point observer pain score (OPS). Patients and observer were blinded to the medication given. The duration of absolute analgesia was defined as the time from caudal injection until the pain score was >2. Motor block was assessed by modified Bromage scale. Statistical analysis was performed with Chi-square test, Student's t-test and log-rank test. P < 0.05 were considered as significant. Results: HR and SBP measured at a specific time intervals showed no significant difference. All the patients had adequate intraoperative analgesia. Mean OPS were comparable between two groups. Duration of absolute analgesia was 276.8 (11) min in Group I and 284.8 (12) min for Group II. The only significant difference was the motor-block score at 2, 3 and 4 h after surgery, although the score was same 1 h post-operatively. Conclusion: The efficacy of both ropivacaine and bupivacaine is almost same in terms of onset and duration of analgesia. Therefore, the motor blockade caused by ropivacaine is less; there is no significant difference in cardiovascular events.
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Affiliation(s)
- Ss Chipde
- Department of Anesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India
| | - M Banjare
- Department of Anesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India
| | - Kk Arora
- Department of Anesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India
| | - M Saraswat
- Department of Anesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India
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Maitra S, Baidya DK, Pawar DK, Arora MK, Khanna P. Epidural anesthesia and analgesia in the neonate: a review of current evidences. J Anesth 2014; 28:768-79. [DOI: 10.1007/s00540-014-1796-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/19/2014] [Indexed: 01/16/2023]
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Wang T, Xiang Q, Liu F, Wang G, Liu Y, Zhong L. Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy. J Anesth 2013; 27:650-6. [PMID: 23608774 DOI: 10.1007/s00540-013-1613-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/07/2013] [Indexed: 11/26/2022]
Abstract
PURPOSES Caudal block is one of the most commonly used anesthetic techniques in subumbilical and genitourinary procedures. However, traditional administration of caudal levobupivacaine was inadequate on blocking peritoneal response during spermatic cord traction. The aim of this study was to evaluate whether the addition of caudal sufentanil to levobupivacaine provided better analgesia for children undergoing orchidopexy. METHODS Sixty-two patients, scheduled for right orchidopexy, received caudal block after induction. Group LS (n = 31) received levobupivacaine 0.25% 1 ml/kg plus sufentanil 0.5 μg/kg, and group L (n = 31) received levobupivacaine 0.25% 1 ml/kg only. HR or MAP fluctuation >20% or entropy increase >15% during spermatic cord traction was defined as inadequate anesthesia and was treated with increasing sevoflurane concentration. The number of children who needed sevoflurane rescue was counted, and postoperative side effects and quality of sleep were also recorded. RESULTS There were no statistically significant differences between the two groups in age, weight, and duration of surgery. Two (6.45%) children in group LS required inspired sevoflurane rescue to block hemodynamic fluctuation during spermatic cord traction, as compared with 12 (38.71%) patients in group L (P < 0.001). At the time of exerting spermatic cord traction, the median HR was, respectively, 134 and 145 (P < 0.001); the corresponding response entropy (RE) and state entropy (SE) was 65 and 54, respectively, in group LS versus 76 and 65 in group L (P < 0.001). CONCLUSION In pediatric orchidopexy, the addition of sufentanil to levobupivacaine for caudal blockade offers clinical benefit over levobupivacaine alone in blocking the spermatic cord traction response.
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Affiliation(s)
- Tingting Wang
- Department of Anesthesia, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Locatelli BG, Ingelmo PM, Emre S, Meroni V, Minardi C, Frawley G, Benigni A, Di Marco S, Spotti A, Busi I, Sonzogni V. Emergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale. Paediatr Anaesth 2013; 23:301-8. [PMID: 23043512 DOI: 10.1111/pan.12038] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVES/AIM This randomized control trial was designed to evaluate the incidence of emergence delirium (ED) in preschool children receiving sevoflurane or desflurane anesthesia combined with an effective caudal block. BACKGROUND While ED has been described in children receiving sevoflurane or desflurane anesthesia, a direct comparison between the two agents using a validated ED assessment tool has not been reported previously. METHODS/MATERIALS Two hundred and sixty preschool children scheduled for elective sub-umbilical surgery were randomized to receive sevoflurane or desflurane anesthesia combined with a caudal block. ED was defined as a Paediatric Anesthesia Emergence Delirium scale (PAED) ≥ 10 points. A delirium-specific score (ED I) was calculated from the first three items of the PAED score (eye contact, purposeful actions, awareness of the surroundings) and a nonspecific score (ED II) from the last two items on the PAED score (restlessness and inconsolability) to test the hypothesis that some items of the PAED scale may better reflect clinical ED than others. RESULTS Thirty-one (25%) children in each group demonstrated ED after awakening with ED being of shorter duration in the desflurane group than the sevoflurane group. An ED I score of nine points had a sensitivity of 0.93 and a specificity of 0.94 for ED. An ED II score of five points had a sensitivity of 0.34 and specificity of 0.95 for ED. CONCLUSION Sevoflurane and desflurane anesthesia were associated with similar incidences of ED in children undergoing sub-umbilical surgery and receiving effective regional anesthesia. High scores on the first three items of the PAED scale were highly correlated with ED. The items restlessness and inconsolability had lower sensitivity for the diagnosis of ED.
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Affiliation(s)
- Bruno G Locatelli
- 1st Service of Anesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy
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Davies K, Wilson G, Engelhardt T. Caudal Additives Do Not Improve the Analgesia Afforded by Levobupivacaine After Hypospadias Repair. Anesth Pain Med 2012; 1:174-177. [DOI: 10.5812/aapm.2629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Davies K, Wilson G, Engelhardt T. Caudal additives do not improve the analgesia afforded by levobupivacaine after hypospadias repair. Anesth Pain Med 2012; 1:174-7. [PMID: 24904788 PMCID: PMC4018700 DOI: 10.5812/kowsar.22287523.2629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 11/11/2011] [Accepted: 11/13/2011] [Indexed: 11/24/2022] Open
Abstract
Background: Caudal analgesia is commonly employed to provide excellent intra- and postoperative analgesia for primary hypospadias repair in children. Several additives to local anesthetics are commonly employed to increase the block duration, although these have uncertain benefits. Objectives: This study investigated whether, in caudal analgesia with levobupivacaine 0.25%, the addition of S (+)-ketamine, clonidine, or both agents combined, would prolong postoperative analgesia in patients undergoing primary hypospadias repair. Patients and Methods: We conducted a retrospective chart analysis for all patients who underwent hypospadias repair with caudal analgesia over a consecutive 3-period at this institution. The study examined four patient groups, classified according to the analgesia used: Primary outcome measures were as follows: time to the first postoperative request for analgesia, total first 24-hour postoperative analgesia, and time to hospital discharge. Results: The 87 patients included had a mean ± SD age of 21.4 ± 13.5 months and weight of 11.9 ± 2.4 kg. The median doses of levobupivacaine, S (+)-ketamine, and clonidine were 0.7 mg/kg (range, 0.4–1.3), 0.5 mg/kg (0.2–1.1), and 1.8 μg/kg (0.8–2.3), respectively. The addition of S(+)-ketamine, clonidine, or both did not increase the time to first oral analgesia request. Neither did it reduce the total first 24-hour postoperative analgesia requirements or alter hospital discharge time. However, the additive drugs in combination did increase postoperative sedation. Conclusions: The addition of S (+)-ketamine or clonidine to levobupivacaine 0.25% in caudal analgesia for hypospadias repair appears to be of no benefit. However, use of the additives in combination increased postoperative sedation.
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Affiliation(s)
- Kay Davies
- Department of Anesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK
| | - Graham Wilson
- Department of Anesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK
| | - Thomas Engelhardt
- Department of Anesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK
- Corresponding author: Thomas Engelhardt, Department of Anesthesia, Royal Aberdeen Children’s Hospital, Westburn Road, Aberdeen, AB25 2ZG, Aberdeen, Scotland, UK. Tel: +44-1224553144, Fax: +44-1224554483, E-mail:
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Thies KC, Driessen J, Kho HG, Kwak K, Knoll J, de Gier R, Feitz W. Longer than expected-duration of caudal analgesia with two different doses of levobupivacaine in children undergoing hypospadias repair. J Pediatr Urol 2010; 6:585-8. [PMID: 20171143 DOI: 10.1016/j.jpurol.2010.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Accepted: 01/18/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess our study design and to obtain preliminary data for a dose-effect study on levobupivacaine for caudal analgesia in patients undergoing hypospadias repair. STUDY DESIGN non randomised, non-blinded pilot study. METHOD For this non-randomized, non-blinded pilot study, 20 patients (median age 17 months, median weight 10.5 kg) were allocated to two groups receiving either 0.5 mL kg(-1) levobupivacaine 0.125% (Group 0) or 0.5 mL kg(-1) levobupivacaine 0.375% (Group 1) caudally after induction of anaesthesia for pain control. No further analgesia was given before, during or after the procedure. Pain scores (Children's and Infants' Postoperative Pain Scale) were recorded throughout the observation period, which lasted from the start of the procedure until hospital discharge on the following day. RESULTS Group 0: six out of 10 patients remained pain free throughout the observation period. Group 1: six out of seven patients remained pain free throughout the observation period. CONCLUSION Both concentrations of levobupivacaine provided excellent analgesia throughout surgery. The postoperative analgesia with both doses of levobupivacaine was found to be significantly longer lasting than previously reported. The study design, with a tight and extensive observation scheme, proved to be feasible, but given the surprisingly long-lasting analgesia, the observation period needs to be extended in future studies.
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Affiliation(s)
- Karl-Christian Thies
- Radboud University Nijmegen Medical Centre, Dept. of Anaesthesia, The Netherlands.
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Dobereiner EFA, Cox RG, Ewen A, Lardner DR. Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects? Can J Anaesth 2010; 57:1102-10. [DOI: 10.1007/s12630-010-9386-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/01/2010] [Indexed: 10/19/2022] Open
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Yildiz TS, Ozdamar D, Bagus F, Solak M, Toker K. Levobupivacaine-tramadol combination for caudal block in children: a randomized, double-blinded, prospective study. Paediatr Anaesth 2010; 20:524-9. [PMID: 20412459 DOI: 10.1111/j.1460-9592.2010.03296.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this prospective study was to compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.125% or caudal tramadol 1.5 mg.kg(-1) and mixture of both in children undergoing day-case surgery. METHODS Sixty-three American Society of Anesthesiologists (ASA) I or II children between 1 and 7 years old scheduled for inguinal hernia repair under sevoflurane anesthesia were randomized to receive caudal levobupivacaine 0.125% (group L), caudal tramadol 1.5 mg.kg(-1) (group T) or mixture of both (group LT) (total volume of caudal solution was 1 ml.kg(-1)). Duration of analgesia and requirement for additional analgesics were noted. Postoperative pain was evaluated using the Children's and Infants' Postoperative Pain Scale (CHIPPS) every 15 min for the first hour, and after 2, 3, 4, 6, 12, and 24 h. Analgesia was supplemented whenever pain score was > or =4. RESULTS No patient experienced significant intraoperative hemodynamic response to surgical incision. Duration of analgesia was significantly longer in group LT than in group L and group T (545 +/- 160 min vs 322 +/- 183 min and 248 +/- 188 min, respectively) (P < 0.01). There were no significant differences between the group L and group T for duration of analgesia (P > 0.05). There were no significant differences among the groups in the number of patients requiring analgesia after operation (P = 0.7). No signs of motor block were observed after the first postoperative hour in any of the patients. CONCLUSION Addition of tramadol increased the duration of analgesia produced by caudal levobupivacaine in children.
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Affiliation(s)
- Tulay S Yildiz
- Department of Anesthesiology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey.
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Abstract
BACKGROUND Caudal extradural blockade is one of the most commonly performed procedures in pediatric anesthesia. However, there is little information available on variations in clinical practice. OBJECTIVES To perform a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland who undertake caudal anesthesia. METHODS An 'online' World Wide Web questionnaire collected information on various aspects of clinical practice. The survey ran from April to June 2008. RESULTS There were 366 questionnaires completed. The majority of respondents had >5 years of pediatric experience and performed up to ten caudal extradural procedures a month. The commonest device used was a cannula (69.7%) with 68.6% using a 22G device. There was a trend toward the use of a cannula in those anesthetists with <15 years experience, while those with >15 years experience tended to use a needle. Most anesthetists (91.5%) did not believe that there was a significant risk of implantation of dermoid tissue into the caudal extradural space. The majority used a combination of clinical methods to confirm correct placement. Only 27 respondents used ultrasound. The most popular local anesthetics were bupivacaine (43.4%) and levobupivacaine (41.7%). The most common additives were clonidine (42.3%) and ketamine (37.5%). The caudal catheter technique was used by 43.6%. Most anesthetists (74%) wear gloves for a single shot caudal injection. CONCLUSIONS This survey provides a snapshot of current practice and acts a useful reference for the development of enhanced techniques and new equipment in the future.
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Affiliation(s)
- Robert Menzies
- Nuffield Department of Anesthetics, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, UK
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Ingelmo P, Frawley G, Astuto M, Duffy C, Donath S, Disma N, Rosano G, Fumagalli R, Gullo A. Relative analgesic potencies of levobupivacaine and ropivacaine for caudal anesthesia in children. Anesth Analg 2009; 108:805-13. [PMID: 19224787 DOI: 10.1213/ane.0b013e3181935aa5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Comparing relative potency of new local anesthetics, such as levobupivacaine and ropivacaine, by the minimum local analgesic concentration model has not been described for caudal anesthesia. Therefore, we performed a prospective, randomized, double-blind study to determine the minimum local analgesic concentrations of a caudal single shot of ropivacaine and levobupivacaine in children and to describe the upper dose-response curve. METHODS We performed a two-stage prospective, randomized, double-blind study comparing the dose-response curves of caudal ropivacaine and levobupivacaine in children. In phase 1, 80 boys were randomized to receive either ropivacaine or levobupivacaine. In the second phase a further 32 patients were randomly allocated to receive caudal anesthesia with doses designed to delineate the upper dose-response range (the 50% effective dose [ED(50)]-ED(95) range). RESULTS There were no significant differences in ED(50) values for caudal ropivacaine and levobupivacaine. The ED(50) for levobupivacaine estimated from the Dixon Massey method was 0.069% (95% CI 0.056%-0.082%) and for ropivacaine was 0.075% (95% CI 0.058%-0.092%). Estimated by isotonic regression the ED(50) and ED(95) respectively of levobupivacaine were 0.068 (0.04-0.09) and 0.20% (95% CI 0.16%-0.24%). For ropivacaine ED 50 and ED95 were 0.066 (0.033-0.098) and 0.225% (95% CI 0.21%-0.24%). CONCLUSIONS In children receiving one minimum alveolar anesthetic concentration of sevoflurane, there were no significant differences in the ED(50) for caudal levobupivacaine and ropivacaine. The potency ratio at ED(50) was 0.92 and 0.89 at ED(95), indicating that caudal levobupivacaine and ropivacaine have a similar potency.
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Affiliation(s)
- Pablo Ingelmo
- Department of Perioperative Medicine and Intensive, A.O. San Gerardo, Monza, Italy
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Yao YS, Qian B, Chen BZ, Wang R, Tan L. The optimum concentration of levobupivacaine for intra-operative caudal analgesia in children undergoing inguinal hernia repair at equal volumes of injectate. Anaesthesia 2009; 64:23-6. [DOI: 10.1111/j.1365-2044.2008.05688.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Saeed A, Khan AR, Lee V, Aslam A, Brain J, Williams MPL, Brennan L, Campbell R, Samuel M. Pain Management for Unilateral Orchidopexy in Children: An Effective Regimen. World J Surg 2008; 33:603-6. [DOI: 10.1007/s00268-008-9847-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galante D, Pellico G, Meola S, Caso A, De Capraris A, Milillo R, Mirabile C, Olivieri M, Cinnella G, Dambrosio M. Hemodynamic effects of levobupivacaine after pediatric caudal anesthesia evaluated by transesophageal doppler. Paediatr Anaesth 2008; 18:1066-74. [PMID: 18950331 DOI: 10.1111/j.1460-9592.2008.02774.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to determine if there are significant differences in hemodynamic effects between combined general-regional anesthesia using levobupivacaine 0.25% 2 ml x kg(-1) via the caudal route in comparison with balanced general anesthesia using continuous infusion of remifentanil in young children undergoing genitourinary surgery. PATIENTS AND METHODS 62 ASA I-II pediatric patients (12 female, 50 male) aged 6 months to 7 years undergoing genitourinary surgery were included in the study. Patients were randomly allocated into one of two groups of 31 patients each. Group Caud received caudal blockade with levobupivacaine 0.25% 2 mg x kg(-1) in combined general-regional anesthesia and Group Gen received balanced general anesthesia with remifentanil. The noninvasive hemodynamic parameters were measured in each group 5 min after induction of general anesthesia or caudal block (Tcaud), after further 5 min coincident with skin incision (Tsi), 10 min after skin incision (T10i), at the end of surgical procedure (Tend). The time between Tcaud and Tsi was 10 min and the measurements during the interval time T10i-Tend were performed every 15 min according to the duration of surgical procedures. RESULTS There was a decrease in all measured hemodynamic parameters at skin incision. The decreases occurred in both groups with those in the caudal group occurring at skin incision and those in the balanced anesthesia group occurring at 10 min after skin incision. These variations showed no significant differences for any of the stated outcomes; neither between the groups at each time point nor in the caudal in comparison with baseline measurements. CONCLUSIONS Using transesophageal Doppler no differences in hemodynamic parameters could be detected between balanced general anesthesia with either caudal levobupivacaine or remifentanil infusion. Both techniques showed good hemodynamic stability with only minor changes from baseline over time which are unlikely to be of clinical significance except possibly in patients with preexisting cardiovascular compromise. Other studies with noninvasive monitoring in a larger population are required to better understand the consequences of caudal blockade on CO and on regional blood flow in infants.
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Affiliation(s)
- Dario Galante
- University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti of Foggia, Italy, University of Foggia, Italy.
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Erol A, Tavlan A, Tuncer S, Topal A, Yurtcu M, Reisli R, Otelcioglu S. Caudal anesthesia for minor subumbilical pediatric surgery: a comparison of levobupivacaine alone and levobupivacaine plus sufentanil. J Clin Anesth 2008; 20:442-6. [PMID: 18929285 DOI: 10.1016/j.jclinane.2008.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 04/16/2008] [Accepted: 04/22/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Atilla Erol
- Department of Anaesthesiology and Intensive Care, University of Selcuk of Meram Medicine Faculty, Konya, Turkey.
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Alves MMO, Carvalho PRA, Wagner MB, Castoldi A, Becker MM, Silva CC. Cross-validation of the Children's and Infants' Postoperative Pain Scale in Brazilian Children. Pain Pract 2008; 8:171-6. [DOI: 10.1111/j.1533-2500.2008.00192.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Locatelli B, Frawley G, Spotti A, Ingelmo P, Kaplanian S, Rossi B, Monia L, Sonzogni V. Analgesic effectiveness of caudal levobupivacaine and ketamine. Br J Anaesth 2008; 100:701-6. [DOI: 10.1093/bja/aen048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ingelmo P, Locatelli BG, Frawley G, Knottenbelt G, Favarato M, Spotti A, Fumagalli R. The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions. Paediatr Anaesth 2007; 17:1166-75. [PMID: 17986035 DOI: 10.1111/j.1460-9592.2007.02327.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is no consensus on the concentration or type of local anesthetic used for initiation of epidural anesthesia. The aim of this randomized, double-blind, controlled trial was to compare the clinical effectiveness of epidural administration of both levobupivacaine and bupivacaine in 0.2% and 0.25% concentrations in pediatric patients undergoing abdominal and urological surgery. METHODS One hundred and forty-one children scheduled for lower abdominal and urological surgery were randomized to receive 0.4-0.6 ml.kg(-1) epidural, 0.25% bupivacaine, 0.2% bupivacaine, 0.25% levobupivacaine or 0.2% levobupivacaine. Initial epidural volumes, onset times; hemodynamic consequences, postoperative pain scores and degree of residual postoperative motor block were all recorded. RESULTS There were no significant differences in the proportion of children with effective analgesia after incision [0.20% bupivacaine 97%, 0.25% bupivacaine 94%, 0.20% levobupivacaine 91%, 0.25% levobupivacaine 92% (P=0.73)] when a median volume of 0.55 ml.kg(-1) was used. There was no association between the volume used for thoracic, lumbar, or sacral epidural anesthesia and the effectiveness of the agents used. There was a significantly greater incidence of pain on awakening with the 0.2% solutions compared with the 0.25% solutions, but no differences in the incidence of residual motor block between groups. CONCLUSIONS While there is no difference in the proportion of effective surgical anesthesia, the lower incidence of pain and distress with the 0.25% solutions suggests that this concentration has clinical advantages over the 0.2% solutions for pediatric epidural anesthesia.
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Affiliation(s)
- Pablo Ingelmo
- Department of Anaesthesia and Intensive Care, A.O San Gerardo, Monza, Italy
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Galante D, Dambrosio M, Cinnella G, Pellico G, Federico A, Pugliese P, Sforza D. Volatile agents and caudal block. Paediatr Anaesth 2007; 17:398-9; author reply 400. [PMID: 17359415 DOI: 10.1111/j.1460-9592.2006.02109.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
MESH Headings
- Amides/adverse effects
- Amides/pharmacokinetics
- Amides/therapeutic use
- Anesthesia, Caudal/methods
- Anesthesia, General/methods
- Anesthetics, Combined/adverse effects
- Anesthetics, Combined/therapeutic use
- Anesthetics, Inhalation/adverse effects
- Anesthetics, Inhalation/therapeutic use
- Anesthetics, Local/adverse effects
- Anesthetics, Local/pharmacokinetics
- Anesthetics, Local/therapeutic use
- Bupivacaine/adverse effects
- Bupivacaine/analogs & derivatives
- Bupivacaine/pharmacokinetics
- Bupivacaine/therapeutic use
- Child
- Child, Preschool
- Dose-Response Relationship, Drug
- Humans
- Infant
- Infant, Newborn
- Levobupivacaine
- Methyl Ethers/adverse effects
- Methyl Ethers/therapeutic use
- Ropivacaine
- Sevoflurane
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Ingelmo PM, Bendall EJ, Frawley G, Locatelli BG, Milan B, Lodetti D, Fumagalli R. Bupivacaine caudal epidural anesthesia: assessing the effect of general anesthetic technique on block onset. Paediatr Anaesth 2007; 17:255-62. [PMID: 17263741 DOI: 10.1111/j.1460-9592.2006.02090.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The primary objective of this prospective, randomized trial was to compare the effect of propofol and sevoflurane on effectiveness of regional anesthesia. As a secondary objective, we aimed at evaluating the influence of age on neuraxial block profile. METHODS One hundred and thirteen healthy children aged <10 years, scheduled for general or urological surgical procedures were randomly allocated to receive either propofol or sevoflurane induction and maintenance. Children received caudal or lumbar epidural block depending on their weight and expected surgery. Time to onset of surgical anesthesia, intraoperative analgesic effectiveness, residual motor blockade, postoperative pain, and adverse effects were evaluated. To assess the influence of age on these measures children were further divided into three age groups: 0-24, 25-60 and >60 months. RESULTS The mean time to onset of surgical anesthesia was significantly shorter in the sevoflurane group than the propofol group (3.1 vs 4.7 min, P < 0.01), independent of the type of regional technique employed. Distress on arousal in recovery was increased in children receiving sevoflurane (P = 0.03). There was no significant difference in residual motor blockade between the groups but children between 0 and 24 months receiving sevoflurane had a higher incidence of residual motor blockade 3 h after local anesthetic injection (P = 0.01). CONCLUSIONS This study has demonstrated that general anesthesia with sevoflurane decreases the time to onset of surgical anesthesia relative to propofol anesthesia. This effect was most marked when sevoflurane anesthesia preceded caudal epidural blockade. The basis for this effect is most likely to be related to differential binding of the two anesthetic agents to receptors in the spinal cord that mediate immobility in response to surgical stimuli.
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Affiliation(s)
- P M Ingelmo
- Department of Anaesthesia and Intensive Care, A.O. San Gerardo, Monza, Italy
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Iwasaki T, Takahashi Y, Kimura Y, Yamazaki H, Yamaguchi S, Kitajima T. Comparison of 0.25% Levobupivacaine, 0.25% Bupivacaine, and 0.125% Bupivacaine for Duration and Magnitude of Action in Peripheral Arterial Blood Flow Induced by Sympathetic Block in Dogs: . Reg Anesth Pain Med 2007; 32:97-101. [DOI: 10.1097/00115550-200703000-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ingelmo PM, Locatelli BG, Sonzogni V, Gattoni C, Cadisco A, Lorini M, Sora GN, Fumagalli R. Caudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double-blind, randomized, controlled trial. Paediatr Anaesth 2006; 16:955-61. [PMID: 16918658 DOI: 10.1111/j.1460-9592.2006.01903.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We hypothesized that without the analgesic effects of volatile anesthetics, caudal 0.20% ropivacaine would be less effective during surgical stimulation than 0.20% bupivacaine or 0.20% levobupivacaine. This trial was designed to examine whether the combination of a caudal block with 0.20% ropivacaine and i.v. anesthesia resulted in reduced analgesic efficacy during surgery compared with caudal 0.20% levobupivacaine or 0.20% bupivacaine in children. METHODS Ninety ASA I-II children between 1 and 7 years old, scheduled for inguinal hernia repair or orchidopexy under propofol anesthesia were randomized to receive a caudal block with 1 ml x kg(-1) of 0.2% bupivacaine, 0.2% ropivacaine or 0.2% levobupivacaine. The primary outcome measure of the study was the clinical efficacy of the caudal block during surgery. Secondary outcome measures were postoperative pain relief and residual motor blockade. RESULTS Four children were excluded and 86 were analyzed. The proportion of children with effective caudal block during surgery was significantly higher in children receiving levobupivacaine (26/28) or bupivacaine (27/29) compared with patients receiving ropivacaine (21/29) (P = 0.03). There were no significant differences among groups in the analgesic onset time (P = 0.1), incidence of residual motor blockade (P = 0.4), number of patients requiring analgesia after operation or in the time from caudal injection to the first administration of analgesic medication (P = 0.3). CONCLUSIONS Combined with propofol anesthesia, 0.2% levobupivacaine and 0.2% bupivacaine are more effective than 0.2% ropivacaine for caudal use in children undergoing inguinal hernia repair or orchidopexy.
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Affiliation(s)
- Pablo M Ingelmo
- Anaesthesia and Intensive Care Department, Ospedali Riuniti di Bergamo, Bergamo, Italy.
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von Ungern-Sternberg BS, Regli A, Frei FJ, Hammer J, Schibler A, Erb TO. The effect of caudal block on functional residual capacity and ventilation homogeneity in healthy children*. Anaesthesia 2006; 61:758-63. [PMID: 16867088 DOI: 10.1111/j.1365-2044.2006.04720.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Caudal block results in a motor blockade that can reduce abdominal wall tension. This could interact with the balance between chest wall and lung recoil pressure and tension of the diaphragm, which determines the static resting volume of the lung. On this rationale, we hypothesised that caudal block causes an increase in functional residual capacity and ventilation distribution in anaesthetised children. Fifty-two healthy children (15-30 kg, 3-8 years of age) undergoing elective surgery with general anaesthesia and caudal block were studied and randomly allocated to two groups: caudal block or control. Following induction of anaesthesia, the first measurement was obtained in the supine position (baseline). All children were then turned to the left lateral position and patients in the caudal block group received a caudal block with bupivacaine. No intervention took place in the control group. After 15 min in the supine position, the second assessment was performed. Functional residual capacity and parameters of ventilation distribution were calculated by a blinded reviewer. Functional residual capacity was similar at baseline in both groups. In the caudal block group, the capacity increased significantly (p < 0.0001) following caudal block, while in the control group, it remained unchanged. In both groups, parameters of ventilation distribution were consistent with the changes in functional residual capacity. Caudal block resulted in a significant increase in functional residual capacity and improvement in ventilation homogeneity in comparison with the control group. This indicates that caudal block might have a beneficial effect on gas exchange in anaesthetised, spontaneously breathing preschool-aged children with healthy lungs.
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Abstract
BACKGROUND Levobupivacaine is the pure S-enantiomer of bupivacaine. Despite obvious benefits in the event of accidental intravascular injection there has been no studies demonstrating a clinically significant benefit to levobupivacaine over racemic bupivacaine for pediatric regional anesthesia. Given the similar pharmacokinetic profiles of both drugs the studies to date have been underpowered to demonstrate what is likely to be a small difference in clinical effectiveness. Our aim was to determine if there are significant differences in the clinical effectiveness of levobupivacaine compared with racemic bupivacaine for caudal anesthesia in children having lower abdominal surgery. A secondary aim was to determine if there are differences in the incidence of postoperative motor blockade between these agents. METHODS Three hundred and ten children ranging in age from 1 month to 10.75 years in age having lower abdominal surgery were enrolled. Patients were randomized in a double blind manner to receive a caudal block with either 0.25% bupivacaine (n = 152) or 0.25% levobupivacaine (n = 155) to a total volume of 1 ml x kg(-1). Motor blockade (modified Bromage scale) and postoperative pain or distress (FLACC behavioral scale for postoperative pain) were measured at predetermined time points during the subsequent 120 min. RESULTS There were no significant adverse effects attributable to levobupivacaine. Success rates were defined as a lack of hemodynamic response to first surgical incision and low postoperative pain scores. At a mean duration of 5 min between block completion and first incision success for 1 ml x kg(-1) of 0.25% bupivacaine was 91% and 94% for 0.25% levobupivacaine. Satisfactory postoperative analgesia was present in 98% of patients after bupivacaine caudal anesthesia and 97.5% for levobupivacaine. At 30 min following caudal anesthesia the incidence of postoperative motor block with racemic bupivacaine was 84% and decreased to 7% at 120 min. For levobupivacaine motor block at 30 min postcaudal was present in 85% and decreased to 11% at 120 min. CONCLUSIONS Levobupivacaine is an effective agent for caudal anesthesia in children at a recommended dose of 2.5 mg x kg(-1). The rapidity of onset was suitable for establishment of surgical anesthesia and postoperative analgesia was achieved in greater than 97.5% of patients. It appears to be of equivalent potency to racemic bupivacaine in children requiring lower abdominal surgery.
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Affiliation(s)
- Geoff P Frawley
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Flemington Road Parkville, Melbourne, Vic., Australia.
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Abstract
Ropivacaine (Naropin) is the pure S(-)-enantiomer of propivacaine, and is a long-acting amide local anaesthetic agent, eliciting nerve block via reversible inhibition of sodium ion influx in nerve fibres. Ropivacaine is a well tolerated regional anaesthetic effective for surgical anaesthesia as well as the relief of postoperative and labour pain. The efficacy of ropivacaine is similar to that of bupivacaine and levobupivacaine for peripheral nerve blocks and, although it may be slightly less potent than bupivacaine when administered epidurally or intrathecally, equi-effective doses have been established. Clinically adequate doses of ropivacaine appear to be associated with a lower incidence or grade of motor block than bupivacaine. Thus ropivacaine, with its efficacy, lower propensity for motor block and reduced potential for CNS toxicity and cardiotoxicity, appears to be an important option for regional anaesthesia and for the management of postoperative and labour pain.
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Affiliation(s)
- Dene Simpson
- Adis International Limited, Auckland, New Zealand.
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Nayyar MS, Yates C. Bupivacaine as pre-emptive analgesia in third molar surgery: Randomised controlled trial. Br J Oral Maxillofac Surg 2006; 44:501-3. [PMID: 16457912 DOI: 10.1016/j.bjoms.2005.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Accepted: 09/07/2005] [Indexed: 10/25/2022]
Abstract
We conducted a prospective, randomised study on the use of pre-emptive analgesia in 45 patients who had bilateral impacted third molars removed. Bupivacaine 0.5% with adrenaline 1:200,000 was injected on one side, the other side acting as control. A visual analogue scale was used to measure the extent of postoperative pain. There was a significant reduction (p = 0.05) in postoperative pain on the injected side at 6, 12, and 72 h and an overall reduction in pain up to 7 days.
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Affiliation(s)
- M Sharif Nayyar
- National Maxillofacial Unit, Registrar Maxillofacial Unit, St James Hospital, Dublin 8, Republic of Ireland.
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Abstract
Levobupivacaine [S(-)bupivacaine], the levorotatory S-enantiomer of racemic bupivacaine, is commercially available in the U.S. and in most European countries. We performed a systematic review (MEDLINE database) and identified 88 articles on the clinical application of levobupivacaine in more than 3,000 patients. The use of levobupivacaine is described for epidural, caudal, and spinal anesthesia, for peripheral nerve blocks, for ophthalmic and dental anesthesia, for different pediatric indications and for intravenous regional anesthesia. In these regional techniques, levobupivacaine was used for all common indications in a wide range of clinical settings. Epidural levobupivacaine was combined with fentanyl, morphine, sufentanil, epinephrine, and clonidine, spinal levobupivacaine was combined with sufentanil, fentanyl, and epinephrine. In most studies, levobupivacaine was compared to bupivacaine and/or ropivacaine.
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Affiliation(s)
- B Urbanek
- Klinik für Anästhesie und Allgemeine Intensivmedizin, Allgemeines Krankenhaus, Medizinische Universität, Wien
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