Introduction.The use of regional anesthetic techniques in children has been increased due to the adequate pain relief offered during intraoperative as well as postoperative period. Ropivacaine is a new aminoamide local anaesthetic recently studied on adults. its main characteristics seem to be less motor block, less cardiotoxicity and same duration of analgesia in comparison to bupivacaine ( 1 ). Not so many data are available in international literature about ropivacaine use in children (2). The present study was designed to compare epidural administration of ropivacaine vs. bupivacaine in paediatric patients undergoing hypospadia repairs, evaluating wheter ropivacaine is suitable for epidural anesthesia and if it prolonges postoperative analgesia compared to bupivacaine. Methods.After parental informed consent and IRB approval, ASA 1 patients (n=24), aged 2-7 years undergoing hypospadia repairs (mean duration 125 + 17 min) received premedication with oral diazepam. General anesthesia was induced and maintained with halothane in O2/air; after LMA placement, atracurium was given to facilitate mechanical ventilation during surgery. Lumbar epidural block was performed at L5-Si in lateral position with a Tuohy 19G needle (Portex Minipack: Hythe, Kent, England) using an epidural catheter. In a double blind study, patients were randomly allocated to Group R (ropivacaine) or Group B (bupivacaine) ; patients in group R received 2 mg kg"1 of ropivacaine, while patients in group B received 2.5 mg kg ' of bupivacaine. HR, NIBP, EtC02, SpO2were recorded intraoperatively while HR, SpO2 and RR in the postoperative period. We evaluated the onset time of block by pinprick ( easy to detect because of the light anaesthesia, by tachycardia, midriasis or movements) and the duration of postoperative analgesia ( time from the performance of epidural block to the first analgesic administration) by Hannallah-Broadman pain scale, hourly observed. ANOVA and Student's t-test with Bonferroni correction were used for demographic data, HR, NIBP, SpO2 ; onset time of the block, duration of surgery and duration of analgesia were evaluated with Mann Whitney U test. The need for analgesia was tested by Chi2 with Yates Correction. P 0.05 was considered statistically significant. Results.There was not any significative difference between the two groups in relation to age, weight or duration of surgical procedure or onset of analgesia. Surgery started 15 min after local anesthetic administration without any problem ; a T10 level was considered satisfactory. No statistical differences were observed in respect to hemodynamic parameters . The OPS score was lower in group R than in Group B ( 3.6 + 0.5 and 5.5 + 0.9 respectively; p <0.05). First analgesic supplementation ( epidural infusion of bupivacaine plus clonidine) took place 300 min in group R and 225 min in group B after local anesthetic administration . No motor block was observed at awakening in any patient. All patients started NPO six hours after surgery; two patients of group R and three patients of group B had vomiting postoperatively. All patients had urinary catheter or epicistostomy in the postoperative phase. All epidural catheters have been removed 48 hours after surgery. Discussion.Our study demonstrates that administration of ropivacaine 0.2% by epidural route allows an adequate perioperative analgesia as well as bupivacaine 0.25%; ropivacaine gave a superior analgesia not only in terms of duration but also in quality, probably due to the concentration used (3). Motor block was not observed in both groups due to low concentration of anesthetics used. Ropivacaine seems to be safe and effective for hypospadia repairs in pédiatrie patients. References.
|Number of pages||1|
|Journal||Regional Anesthesia and Pain Medicine|
|Issue number||3 SUPPL.|
|Publication status||Published - 1998|
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine