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.

Ingelmo, P., Locatelli, B., Frawley, G., Knottenbelt, G., Favarato, M., Spotti, A., et al. (2007). The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions. PAEDIATRIC ANAESTHESIA, 17(12), 1166-1175 [10.1111/j.1460-9592.2007.02327.x].

The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions

INGELMO, PABLO MAURICIO;FUMAGALLI, ROBERTO
2007

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.
Articolo in rivista - Articolo scientifico
epidural anesthesia; levobupivacaine; bupivacaine
English
1166
1175
Ingelmo, P., Locatelli, B., Frawley, G., Knottenbelt, G., Favarato, M., Spotti, A., et al. (2007). The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions. PAEDIATRIC ANAESTHESIA, 17(12), 1166-1175 [10.1111/j.1460-9592.2007.02327.x].
Ingelmo, P; Locatelli, B; Frawley, G; Knottenbelt, G; Favarato, M; Spotti, A; Fumagalli, R
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/5156
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