Relative analgesic potencies of levobupivacaine and ropivacaine for caudal anesthesia in children

Pablo Ingelmo, Geoffc Ingelmo, Marinella Astuto, Chris Duffy, Susan Donath, Nicola Disma, Giuseppe Rosano, Roberto Fumagalli, Antonio Gullo

Research output: Contribution to journalArticlepeer-review


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 doseresponse 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 ED50 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 ED95 respectively of levobupivacaine were 0.068 (0.04-0.09) and 0.20% (95% CI 0.16%-0.24%). For ropivacaine ED 50 and ED 95 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.

Original languageEnglish
Pages (from-to)805-813
Number of pages9
JournalAnesthesia and Analgesia
Issue number3
Publication statusPublished - Mar 2009

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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