Optimum concentration of bupivacaine for combined caudal-general anesthesia in children

• Published in: Anesthesiology (Philadelphia) Vol. 75; no. 1; pp. 57 - 61
• Main Authors: GUNTER, J. B, DUNN, C. M, BENNIE, J. B, PENTECOST, D. L, BOWER, R. J, TERNBERG, J. L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.07.1991
• Subjects: Ambulatory Surgical Procedures; Anesthesia Recovery Period; Anesthesia, Caudal; Anesthesia, General; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Bupivacaine; Child; Dose-Response Relationship, Drug; Double-Blind Method; Hemodynamics; Humans; Infant; Intraoperative Period; Medical sciences; Neuropharmacology; Pain, Postoperative; Pharmacology. Drug treatments; Prospective Studies; Human; Local anesthetic; Hernia; Caudal anesthesia; Regional anesthesia; Surgery; Extradural administration; General anesthesia; Digestive diseases; Herniorrhaphy; Inguinal; Child
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-199107000-00010

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and intraoperative supplementation to general anesthesia for children. To determine the best concentration of bupivacaine for combined general-caudal anesthesia in children, 122 children aged 1-8 yr scheduled for outpatient inguinal herniorrhaphy were randomized to receive, in a double-blind fashion, caudal anesthesia with bupivacaine in one of six concentrations (0.125, 0.15, 0.175, 0.2, 0.225, or 0.25%). After incision, a programmed reduction in inspired halothane resulted, if tolerated by the subject, in an inspired halothane concentration of 0.5% 10 min after incision. End-tidal halothane concentration at hernia sac ligation for subjects receiving 0.175% bupivacaine (0.55 +/- 0.03%) was less than that for subjects receiving 0.15% bupivacaine (0.75 +/- 0.05%; P less than 0.05). Subjects receiving 0.175% bupivacaine also were discharged earlier from the postanesthesia care unit (PACU) (27 +/- 1 min) than were subjects receiving 0.15% bupivacaine (38 +/- 5 min; P = 0.05). Children receiving greater than or equal to 0.2% bupivacaine tended to complain more of leg weakness after surgery; however, the difference did not reach statistical significance (39 of 67 vs. 16 of 47; P = 0.057). The incidence of complaints of leg weakness and paresthesia was positively correlated with bupivacaine concentration (r = 0.706; P = 0.05). Subjects receiving 0.125% bupivacaine had higher pain scores on arrival to the PACU than did those receiving 0.2% bupivacaine (P = 0.05); there were no other differences in pain scores.