Randomized clinical trial of local ropivocaine perfusion versus bupivacaine for pain relief after laparotomy in children

ABSTRACT

Opioids are often used to decrease pain following laparotomy but are associated with unwanted side-effects. The effectiveness of local perfusion of bupivacaine 0.5 percent versus ropivacaine 0.5 percent following laparotomy was studied. A prospective randomized study involving patients undergoing laparotomy using midline incision was undertaken. Patients were randomized to receive continuous wound perfusion of either bupivacine 0.5 percent or ropivacaine 0.5 percent. Forty patients were recruited, 20 in each group, patient age, height, weight, surgical procedure duration, and complications were comparable in the two groups. The wound lengths were similar [median 14 cm in both groups]. There was statistically significant difference in the postoperative pain scores at rest and with movement between the two groups. One patient in bupivacaine group developed CNS toxicity and two patients in the same group developed transient hypotension and one patient developed transient hypotension in ropivacaine group. Three patients in bupivacaine group experienced repeated vomiting and one patient in ropivacaine group experienced vomiting. Mild wound redness occurred in one patient in each group and staphylococcus epidermidis was cultured from the catheter tip in 3 patients of each group. Direct continuous local wound perfusion of bipivacaine 0.5 percent and ropivacaine 0.5 percent is effective for postoperative pain relief after laparotomy in children. Ropivacaine because of lower cardiovascular and central nervous system toxicity in comparison to bupivacaine is better to be used in children safely