A COMPARATIVE STUDY OF LEVOBUPIVACAINE AND RAC-BUPIVACAINE FOR CAUDAL ANALGESIA IN PAEDIATRIC SUBUMBILICAL SURGERIES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 11
Abstract
BACKGROUND Safety margin of various local anaesthetics have been analysed in the context of toxicity. Many studies have shown that Levobupivacaine has a higher safety profile, but there have been very few studies demonstrating an overwhelming benefit of Levobupivacaine over racemic Bupivacaine for paediatric regional anaesthesia. MATERIALS AND METHODS A randomised, double-blinded study was aimed to determine the presence of clinically significant differences in the analgesic efficacy and motor blockade of Levobupivacaine and Bupivacaine for caudal block under propofol based anaesthesia in children. After obtaining Ethical Committee approval and informed written parental consent, sixty children 2 - 12 years of either sex belonging to ASA PS I - II, undergoing elective subumbilical surgeries were equally randomised and received 1 mL/kg, 0.25% of either Levobupivacaine (Group L) or Bupivacaine (Group B) caudally. Intraoperatively, onset of analgesia and haemodynamic variability were noted. Caudal block was assessed using FLACC pain score (0-10), time for first rescue analgesia and motor blockade with Modified Bromage score (0 - 3). Statistical analysis was done with SPSS version 16.0. The independent ‘t’ test, chi-square or Fisher’s exact test were used to analyse the variables. Significance was defined as ‘p’ value was < 0.05. RESULTS Onset of analgesia was 21.68 ± 1.28 minutes in Group B and 26.12 ± 1.48 minutes in Group L, showing statistical significance (p value= 0.01). BP (systolic and diastolic) was significantly lower in Group B at 25, 30, 45 and 60 minutes. FLACC pain score at recovery was < 3 in both groups. Time for first rescue analgesia was 313.20 ± 63.10 minutes in Group B and 345.60 ± 73.55 minutes in Group L (p value > 0.05). Motor blockade at 120 minutes showed that complete recovery (score 0) was 36% higher in Group L than Group B (p value- 0.02). CONCLUSION Onset of analgesia was delayed with Levobupivacaine. Analgesic efficacy at recovery and time for first rescue analgesia were similar in both groups. Motor blockade was lesser with Levobupivacaine at 120 minutes when compared to Bupivacaine.
Authors and Affiliations
Leo Sundararajan, Prasannavani Vanamail
Keywords
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- EP ID EP411331
- DOI 10.14260/jemds/2018/299
- Views 101
- Downloads 0
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