Comparison of ropivacaine 0.1% and 0.2% with bupivacaine 0.2% for single‐shot caudal anaesthesia in children

Abstract

We compared analgesic efficacy and degree of motor block induced by ropivacaine 0.1% (R 0.1) and 0.2% (R 0.2) vs. bupivacaine 0.2% (B 0. 2) after caudal anaesthesia in children. Total and free plasma concentrations were measured after caudal injection. Duration of caudal analgesia (median/range) was significantly shorter in group R 0.1 (1.7 h/0.2-6 h) than in group R 0.2 (4.5 h/1.7-6 h) or group B 0. 2 (4 h/1-6 h) (P<0.05). Motor block in the first 2 h postoperatively was significantly less for both ropivacaine groups compared with bupivacaine (P<0.05). Peak plasma concentrations after ropivacaine 0.2% were higher and protein binding lower than after bupivacaine 0.2% (P<0.05). We conclude that caudal analgesia with ropivacaine 0.1% is less effective and of shorter duration than that of ropivacaine 0.2%, whereas ropivacaine 0.2% provides pain relief similar to bupivacaine 0.2%. Motor block in the early postoperative period is less with ropivacaine than with bupivacaine.

In children, the addition of epinephrine modifies the pharmacokinetics of ropivacaine injected caudally

“…Further studies are required to determine whether adding epinephrine to ropivacaine results in a prolonged duration of action and whether it effectively helps in detecting an iv injection. 22 C max = maximal plasma concentration; T max = time to C max ; Cl = clearance; Vd = distribution volume; plain = plain ropivacaine; E + = ropivacaine + epinephrine; NA = results not available.…”

Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects?

“…Seventeen such RCTs were reviewed in detail using a structured methodology. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Two review articles were also identified. 18,19 The reference lists for all of these 19 publications were reviewed to identify any further RCTs that may have been missed with the initial search strategy; no such study was found.…”

“…Overall, it appears that most of the studies (with two notable exceptions) included in this evidence-based clinical update compared ''nearly'' equipotent doses of the drugs. 5,17 This then represents a slight weakness in the methodology of most of the studies reviewed.…”

The Efficacy of Intra-Articular Injections for Pain Control Following the Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures

“…Some authors have reported that, during pediatric tonsillectomies, peritonsillar infiltration of bupivacaine and ropivacaine are equally effective 36 , whereas others have reported that bupivacaine provides superior pain relief 37 . When used caudally in children, ropivacaine and bupivacaine have been reported to be equally effective [38][39][40] . Comparisons of the two drugs as intra-articular injections either have shown no difference in effectiveness 41 or have shown ropivacaine to be more effective than bupivacaine 14 .…”

“…In a meta-analysis of the analgesic efficacy of intra-articular injections, there was a nonsignificant difference (p = 0.196) in the dose of local anesthetics given in the studies that demonstrated a significant positive effect of intra-articular injection on postoperative pain as compared with studies that demonstrated no effect. Furthermore, Luz et al reported that single shot of caudal anesthesia with 0.1% ropivacaine was significantly less effective than 0.2% bupivacaine in children, but when a equipotent concentration (0.2%) was used, ropivacaine was found to be equally as effective 40 . Because of differences in the concentrations of the local in the present study anesthetics (0.20% compared with 0.25%), the mean difference in the dose of the local anesthetic administered in the ropivacaine and bupivacaine groups was 0.04 mg/kg.…”