A randomized-controlled, double-blind comparison of the postoperative analgesic efficacy of caudal bupivacaine and levobupivacaine in minor pediatric surgery / 대한마취과학회지

BACKGROUND: We compared the postoperative analgesic efficacy of caudal levobupivacaine with bupivacaine in pediatric subumbilical surgery. METHODS: Sixty American Society of Anesthesiologists I-II patients scheduled for elective minor surgery (1.5-7 years old) were randomly divided into three groups to receive caudal injections of study drugs at 0.5 ml/kg. All patients received 0.1 mg/kg oral midazolam 30 min before surgery. Group B received 0.125% bupivacaine, group L received 0.125% levobupivacaine, and group LF received 0.125% levobupivacaine + 0.5 microg/kg fentanyl. Blood pressure, heart rate and sedation (using a four-scale sedation score) were monitored perioperatively. During the postoperative period, an anesthesiologist blinded to the study groups used the Children's and Infants' Postoperative Pain Scale to monitor patients' pain and degree of sedation. The time before the first rescue analgesic was recorded as well as any side effects over the next 24 h. RESULTS: The four-scale sedation and postoperative pain scale scores in all groups were identical. Blood pressure and heart rate measured at 15 min postoperatively were lower, and time to first rescue analgesic was longer, in Group LF compared to the others. CONCLUSIONS: Caudal 0.5 ml/kg of 0.125% bupivacaine and levobupivacaine are equally effective for postoperative analgesia after subumbilical surgeries in pediatric patients. Addition of fentanyl may lower the required amount of local anesthetics.

Epidural analgesia and vaginal delivery in a patient with aortic stenosis and insufficiency

To report a successful vaginal delivery using slow infusion of epidural analgesia in a patient with both severe aortic stenosis and insufficiency. A 26-year-old primigravid patient presented to our hospital for delivery. She had aortic stenosis and insufficiency due to rheumatic fever. Although the obstetrician recommended cesarean section owing to her cardiac status, she insisted upon vaginal delivery. We performed low-dose epidural analgesia with 10 ml of 0.125% ropivacaine and 20 microg fentanyl. She had spontaneous vaginal delivery without complication. This case showed that in spite of the cardiac pathology, vaginal delivery under low-dose slow infusion of epidural analgesia was successful and therefore may be a safe alternative to cesarean section for cardiac patients

Clinical comparison of 12 mg ropivacaine and 8 mg bupivacaine, both with 20 microg fentanyl, in spinal anaesthesia for major orthopaedic surgery in geriatric patients

The aim of this study was to compare the haemodynamic and anaesthetic effects of 12 mg ropivacaine and 8 mg bupivacaine, both with 20 microg fentanyl, in spinal anaesthesia for major orthopaedic surgery in geriatric patients. Sixty American Society of Anesthesiologists [ASA] II-III patients scheduled for hip arthroplasty were randomly assigned to receive an intrathecal injection of either 12 mg ropivacaine with 20 microg fentanyl [group R, aged 70 +/- 7 years, range 67-89] or 8 mg hyperbaric bupivacaine with 20 microg fentanyl [group B, aged 69 +/- 6 years, range 66-92]. Motor and sensory block, haemodynamics and side effects were recorded. Mean levels of sensory block were similar, but the onset time of sensory block in group B [2.52 +/- 0.69 min] was shorter than that in group R [3.17-0.72 min]; the difference was statistically significant [p < 0.01], and the number of patients who had motor Bromage scale 3 in group B [24] was greater than in group R [16]. The difference was also statistically significant [p<0.05]. Systolic and diastolic arterial pressures [SAP, DAP] and heart rate [HR] decreased after the block in both groups. SAP [after the 60th and 120th mm of block], DAP [all measurement times], and HR [after the 20th, 25th and 30th min of block] were lower in group B than in group R. The data showed that 12 mg of ropivacaine and 8 mg of bupivacaine with 20 microg fentanyl in spinal anaesthesia can provide sufficient motor and sensory block for major orthopaedic surgery in geriatric patients. However, ropivacaine caused less motor block and haemodynamic side effects than bupivacaine during the procedure