Optimum Concentration of Bupivacaine for Combined Caudal-General Anesthesia in Children

Gunter, Joel B.; Dunn, Catherine; Bennie, J B; Pentecost, Diane L.; Bower, Richard J.; Ternberg, Jessie L.

doi:10.1097/00000542-199107000-00010

Cited by 59 publications

(29 citation statements)

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“…Also it is a very common and indispensable component of caudal block because of these features [8]. But for better postoperative pain management due to relatively short duration of action of bupivacaine is a better and a long acting new agent and adjuvant that have been investigated [9].…”

Section: Discussionmentioning

confidence: 99%

Caudal Block with General Anesthesia for Outpatient Pediatric Surgery Procedures

İrşi

Arzu

Firdevs

2017

JACCOA

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Background: Pediatric surgery is mostly done in an outpatient setting and due to this fact preoperative and postoperative pain management is a very important task to overcome. Aim:We aim to share and underline our clinical experience regarding with the children's comfort and parents' satisfaction after outpatient pediatric surgery cases performed under general anesthesia combined with caudal block regional anesthesia. Methods:The files of 405 ASA1 outpatient pediatric surgery patients were retrospectively reviewed. Each inguinoscrotal procedures performed under general anesthesia combined with caudal extradural 1ml/kg bupivacaine. Caudal extradural block was performed just after general anesthesia induction just before the operation. The objective pain score was used to determine child analgesia requirement level postoperatively up to 12 hours. Postoperative pain control was sustained for 48 hours using routine paracetamol and ibuprofen if needed.Results: Combined anesthesia and caudal block during outpatient procedures leads usage of low dose of inhalation anesthetic requirement and early recovery from the anesthetic condition. This was achieved by effective pain control of caudal block. The main concentration of caudal block performed according to the types of outpatient procedures. In hypospadias patient bupivacaine concentration were kept at high level aim to prolong lower extremities immobilization for better recovery. Combined anesthesia with caudal block for outpatient procedures made possible to discharge all most all of the patients as day case surgery. Conclusion:Combined general anesthesia with caudal analgesia with bupivacaine enable us effective and safe per operative pain control beside usage of lower dose of inoperative anesthetic agents makes day case surgery more safer for children with less side effects.

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Section: Discussionmentioning

confidence: 99%

Caudal Block with General Anesthesia for Outpatient Pediatric Surgery Procedures

İrşi

Arzu

Firdevs

2017

JACCOA

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“…Das Spektrum reicht von 0,125%igem [39] über 0,175%igem [78], 0,25%igem [88] bis zu 0,375%igem Bupivacain. Gunter et al [39] untersuchten Bupivacainkonzentrationen von 0,125-0,25%; hierbei erwies sich die 0,125%ige Konzentration besonders in der postoperativen Phase als ungenügend analgetisch wirksam.…”

Section: "Klassische" Lokalanästhetika Bupivacainunclassified

Kaudalanästhesie

2003

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Caudal anaesthesia is the most frequently used regional technique in paediatric anaesthesia. Caudal in combination with general anaesthesia is usually performed in healthy children (i.e. for herniotomy or hypospadias). Therefore every complication of this method is a catastrophe, even when the incidence of these complications is very low. Some of the documented complications of caudal anaesthesia in children are caused by the local anaesthetic solutions and/or by additives. Thus, the choice of substances for paediatric caudal blocks should minimize the risk associated with the substances used for this indication. Over the last decades the standard was bupivacaine but because of serious cardiovascular and central-nervous toxicity following inadvertent intravascular injection of bupivacaine during caudal puncture, the less toxic ropivacaine should be favoured for this indication. A huge number of clinical studies have proven the clinical effectiveness and safety of ropivacaine also for this indication. In addition, levobupivacaine, the L-enantiomere of bupivacaine, will also be an interesting local anaesthetic in the future for paediatric caudal anaesthesia. By using additives to local anaesthetics better analgesic properties should be obtained. Following an exact review of the literature, only clonidine and S(+)-ketamine are useful additives to local anaesthetics in paediatric caudal anaesthesia.

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“…Bupivacaine 0.125-0.175% is the optimum concentration for this purpose, providing equivalent postoperative analgesia to bupivacaine 0.25% (4-8hrs), but with a shorter duration of motor block. 5 The quality and duration of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Both clonidine and dexmedetomidine are alpha 2 adrenergic agonists, which have analgesic properties and potentiate local anesthetic effects.…”

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confidence: 99%

A comparative study of dexmedetomidine versus clonidine in epidural anaesthesia to assess the level of sedation in patients undergoing lower abdominal and lower limb surgery

et al. 2018

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Background: To compare study of dexmedetomidine versus clonidine in epidural anesthesia to assess the level of sedation in patients undergoing lower abdominal and lower limb surgery.Methods: This was a comparative study conducted on admitted ASA grade I and II patients undergoing lower abdominal and lower limb surgeries. The patients were divided into three groups of 30 patients each, according to the epidural medication they received:-Group A-received 15ml of bupivacaine (0.5%) and dexmedetomidine (1.0µg/kg body weight) in 1ml of normal saline; Group B-received 15ml of bupivacaine (0.5%) and clonidine (2.0µg/kg body weight) in 1ml of normal saline; Group C-received 15ml of bupivacaine (0.5%) with 1ml of normal saline. The heart rate, blood pressure, sensory dermatome level, Motor blocked level, pain and VAS were recorded at different time intervals. The side effects were also noted.Results: The baseline parameters were comparable among the groups. All the hemodynamic parameters and other study parameters were similar at Min. 0. All the hemodynamic parameters such as heart rate, blood pressure and SpO2 were variable at different time intervals. Motor block level was significantly (p<0.05) lower in Group C than Group A and Group B from Min 50 to Min 90. The sedation score was observed to be nil in Group C. The post-op pain score became higher in Group C than Group A and Group B at subsequent time intervals. A 3 (10%) of the rescue agents was observed in Group C. Atropine (30%) and mephenteramine (10%) were common rescue agents in Group B. The bradycardia was observed in 30% patients of Group B and in 40% of Group A.Conclusions: On addition of dexmedetomidine as adjuvant to bupivacaine in epidural anesthesia provides better anesthesia and sedation than clonidine as adjuvant to bupivacaine or bupivacaine alone with mild hemodynamic changes which are easily manageable.

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Optimum Concentration of Bupivacaine for Combined Caudal-General Anesthesia in Children

Cited by 59 publications

References 0 publications

Caudal Block with General Anesthesia for Outpatient Pediatric Surgery Procedures

Caudal Block with General Anesthesia for Outpatient Pediatric Surgery Procedures

Kaudalanästhesie

A comparative study of dexmedetomidine versus clonidine in epidural anaesthesia to assess the level of sedation in patients undergoing lower abdominal and lower limb surgery

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