A STUDY COMPARING THE EFFECTIVENESS OF LEVOBUPIVACAINE, BUPIVACAINE AND ROPIVACAINE FOR CAUDAL BLOCK IN CHILDREN UNDERGOING INFRA UMBLICAL PROCEDURES.

Dr. A. Suresh, Dr. P. Shanmugasundaram

Abstract


BACKGROUND: Caudal Epidural anaesthesia plays a vital role in providing effective intra operative as well as post operative pain relief in paediatric population for infraumbilical surgeries. Though Bupivacaine is the most commonly used drug, the availability of drugs like Levobupivacaine and Ropivacaine  with less toxic potentials led us to conduct a study in which we compared the duration of post operative analgesia between these drugs  in children after caudal block for below umbilicus surgeries.AIM: To compare the effectiveness of Levobupivacaine, Bupivacaine and Ropivacaine in a concentration of 0.25% given with volume of 1ml/Kg in caudal block before skin incision  in terms of post operative analgesia and recovery of motor block for surgeries like circumcision and herniotomy in children aged 2-8 years. MATERIALS AND METHODS: This study was conducted in the Department of Anaesthesiology Chengalpattu Medical College; Tamilnadu in 90 paediatric patients of ASA grade I. Patients belonged to the age group of 2-8 years of both sexes. These patients were systematically randomized into groups of 30each. Group I received 0.25% Levobupivacaine (0.5 % solution diluted in equal volumes of normal saline). Group II received 0.25% Bupivacaine (0.5 % solution diluted in equal volumes of normal saline). Group III received0.25% Ropivacaine (0.5 % solution diluted in equal volumes of normal saline) through caudal route. STATISTICAL ANALYSIS: The data was analyzed by statistical software SPSS 19.0 and XLSTAT 2013. All variables were examined for outliers and non-normal distributions. The Categorical variables were expressed as Frequency and percentage. The Quantitative variables were expressed as mean and standard deviation. Descriptive statistics were used to evaluate baseline characteristics. The Group comparison for the categorical variables were analyzed using Chi square test and Quantitative variables were analyzed using Analysis of Variance (ANOVA).A repeated measures analysis of variance (RMANOVA) was used to determine between group effects, within-subject effects, and interactions between groups and time. RESULTS: Three groups were comparable in their base line characteristics like age, sex, weight, height, type and duration of surgery. The duration of post-operative analgesia between these groups were 130.33+11.74min in Group I, 182.83+12.64min in Group II, and 110.17+8.66min in Group III. The time to full motor recovery was significantly lower in Levobupivacaine 0.25% and Ropivacaine 0.25% as compared to the Bupivacaine 0.25%. In Group I it is 180.17+22.76min, in Group II 239.00+21.55min, in Group III 162.00+20.24min. CONCLUSION: Caudal block using Bupivacaine 0.25% in a dose of 1ml/kg provided long lasting analgesia when compared to Levobupivacaine 0.25% and Ropivacaine 0.25% in children undergoing infra-umbilical surgeries. The faster recovery of motor block occurred in Levobupivacaine 0.25% and Ropivacaine 0.25% Group when compared to Bupivacaine Group.

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