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

Authors

  • PABLO INGELMO MD,

    1. Department of Anaesthesia and Intensive Care, A.O San Gerardo, Monza and Dipartimento di medicina sperimentale ambientale e biotecnologie mediche, Università degli Studi Milano Bicocca, Milan, Italy
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  • BRUNO GUIDO LOCATELLI MD,

    1. Department of Anaesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy
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  • GEOFF FRAWLEY MD,

    1. Department of Paediatric Anaesthesia and Pain Management, Royal Childrens Hospital, Melbourne, Vic., Australia
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  • GRAHAM KNOTTENBELT MB ChB FRCA,

    1. Department of Paediatric Anaesthesia and Pain Management, Royal Childrens Hospital, Melbourne, Vic., Australia
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  • MORENO FAVARATO MD,

    1. Department of Anaesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy
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  • ANGELICA SPOTTI MD,

    1. Department of Anaesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy
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  • ROBERTO FUMAGALLI MD

    1. Department of Anaesthesia and Intensive Care, A.O San Gerardo, Monza and Dipartimento di medicina sperimentale ambientale e biotecnologie mediche, Università degli Studi Milano Bicocca, Milan, Italy
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Dr Geoff Frawley. Department of Paediatric Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Vic., Australia (email: geoff.frawley@rch.org.au).

Summary

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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