Ropivacaine Vs Bupivacaine in major surgery in infants

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Introduction: Ropivacaine is a new long acting amide local anesthetic with properties similar to bupivacaine; studies on adults suggest that ropivacaine is less cardiotoxic, with less dense motor block and similar analgesia . (1,2) At this time no data is available in literature about ropivacaine in pediatrics. Aim of this study is to make a comparison between bupivacaine and ropivacaine in pédiatrie major surgey in infants. Methods: after our Ethical Committee approval and Parental Written Consent, in a prospective doubleblind study 20 infants, ranging from 2-12 months, ASA status 1-2, undergoing major surgery (ureteral reimplantation, hydronephrosis), were randomly assigned to one of the two groups. After oral premed with midazolam 0.5 mg/kg, induction was with tiopenthal 3-5 mg/kg and maintenance with sevoflurane 1.5% in U2/air (FjO2 = 0.4), nasal intubation after musclerelaxation (atracurium 0.5 mg/kg). A lumbar block, L3-L4 level, was performed with a LOR technique with air, (Tuohy 19G needle. Portex Kent, UK) Group 1 received 0.25% bupivacaine (0.7 ml/kg) and group 2 0.2% ropivacaine (0.7 ml/kg). HR, BP, time of surgery, onset time to achieve satisfactory block, duration of analgesia (by Broadman OPS) were monitored. ANOVA, Chi-square test and Mann Whitney test correction were used for statistical analysis; p sign < 0.05. Results: no statistical difference in BP, HR, surgery time (106 vs 107 min) and demographic data were noted. The mean onset time was 12.6 and 10.5 min in group 1 and 2 respectively (p = 0.05); 7 children in group 1 needed supplemental analgesia (acetaminophen-codeine rescue) during observating period (24 h) vs 5 children of group 2 ; mean pain free time was 471 (group 1) vs 506 min (group 2). No detectable motor block was observed in both groups at awakening. No vomiting and side effects were evidenced in both groups. Discussion: In our previous study (3) in pédiatrie minor surgery where we evidenced that ropivacaine determines a valid postoperative analgesia (significantly longer than bupivacaine); also in this study 0,2% ropivacaine provides a dense sensory block with an analgesic duration similar to 0.25% bupivacaine. The minor toxicity of the new drug suggests that ropivacaine can be a safe and effective local anesthetic in children. Further investigations are necessary to confirm our data. Reference:.

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