Ropivacaine vs bupivacaine in major surgery in infants

Purpose: To assess and compare the onset time and duration of neuroblockade obtained after ropivacaine or bupivacaine in infants undergoing major abdominal surgery. We also evaluated the efficacy and safety of employing ropivacaine instead of bupivacaine to provide operative anesthesia and postoperative analgesia. Methods: In a prospective double blind study 28 infants, aged 1 - 12 months, undergoing elective major abdominal surgery, were randomly allocated to receive after induction of general anesthesia, either 0.7 ml·kg^-1 bupivacaine 0.25% (group B) or ropivacaine 0.2% (group R) via lumbar epidural block. The onset time-total surgical time and duration of analgesia were recorded. Results: No differences were noted in demographic data, hemodynamic variables or duration of surgery. The onset time for sensory blockade was 13 min ± 2.1 (group B) and 11.7 ± 2.4 min (group R). The duration of analgesia was 491 ± 291 (group R) and 456 min ± 247 (group B). Eight patients in group B and six in group R needed codeine and acetaminophen rescue on at least one occasion during the 24 hr study period. No major side effects were noted in either groups. Conclusions: In infants undergoing major abdominal surgery under combined epidural/light general anesthesia, ropivacaine 0.2% produces sensory and motor blockade similar in onset, duration of action and efficacy to that obtained from an equal volume, 0.7 ml·kg^-1, of bupivacaine 0.25%.