Caudal levobupivacaine with and without fentanyl in pediatric surgery

ABSTRACT

Single dose caudal analgesia is one of the most useful and popular regional blocks used in modem pediatric anesthetic practice. Racemic bupivacaine is commonly used for caudal analgesia however, there have been reports of systemic toxicity. Levobupivacaine was found tobe less toxic than bupivacaine, and produces a block clinically similar to bupivacaine. This study was designed to evaluate the effects of two doses of caudal levobupivacaine with and without fentanyl in children. 90 children ASA 1-11 aged 1-5 yr, undergoing elective hypospedius, circumcision andhemia repair were studied. Anesthesia was induced and maintained with sevoflurane. Spontaneous ventilation was chosen using a laryngeal mask airway. After induction patients were turned to the left lateral position and a caudal block was performed. Patients were randomly divided into three groups to receive a volume of 1 ml.kg[-1] of levobupivacaine 0.25% [group I], 0.125% [Group II] and 0.125% plus fentanyl 2micro g.mL[-1] [group III]. Successful blockade was defined by absence of gross movement or significant [>20%] change in HR, NIBP and/or RR on application of surgical stimulus which was allowed 10 mm after caudal injection. Postoperative analgesia was evaluated by the Children and Infants Postoperative Pain Scale [CHIPPS]. Duration of postoperative analgesia was recorded and CHIPPS and motor weakness were measured every 30 min for the first 6h and every 2h thereafter until the end of the study [24 h]. lntraoperative analgesia was adequate in 96.5%, 93.3% and 93.3% in group 1, 2 and 3, respectively. The duration of postoperative pain relief was significantly prolonged in group I [10.3h] compared with group 2 [6.1 h] and group 3 [6.8h] while no difference was found between group 2 and group 3. Motor blockade score of 1 was observed in 30% of patients in group I during the first postoperative hour and was not observed in any patients in the other two groups P<0.05. Caudal levobupivacaine 0.125% and 0.25% are safe and effective as adjuvant to general anesthesia in children and the higher concentration was associated with early mild motor blockade and longer postoperative analgesia. Fentanyl did not provide any additional benefit when combined with levobupivacaine 0.125%