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Ropivacaine versus bupivacaine in paediatric epidural anesthesia using a new technique

Thesis

Last updated: 06 Feb 2023

Subjects

-

Tags

Anesthesia

Advisors

Shaltout, Foudan F., El-Berairi, Amani E., Abdel-Al, Eiman R.

Authors

Nour, Nadin Burhan

Accessioned

2017-03-30 06:22:47

Available

2017-03-30 06:22:47

type

M.D. Thesis

Abstract

Untreated pain in children is associated with increased morbidity, delayed convalescence and prolonged hospital stay. Several techniques have been developed for intraoperative and postoperative pain control in children, one of which is lumbar epidural analgesia. Ropivacaine, a new long acting amide local anesthetic has less CNS toxicity, cardiotoxicity and wider safety margin than bupivacaine. Extradural ropivacaine produces significantly less motor block than racemic bupivacaine.In the current study, pharmacological testing of bupivacaine and ropivacaine in rabbits both awake and anesthetized was done using 45 rabbits. The convulsive dose of ropivacaine determined by intraperitoneal injection in awake rabbits was: 23.4+3 mg/kg compared to 14.4+2 mg/kg for bupivacaine. Furthermore, the lethal dose which caused circulatory collapse was: 29.12+4 mg/kg in ropivacaine compared to 15.6+2 mg/kg in bupivacaine. IV bolus of ropivacaine caused circulatory collapse in rabbits at a dose of 23.76+3 mg/kg compared to 16.36+2 mg/kg in the bupivacaine group. These results confirm the greater safety of ropivacaine as a local anesthetic.In the current clinical study 40 patients 2-10 years old, ASA physical status I undergoing elective surgical procedures in the lower abdomen or orthopedic surgery in the lower limbs were randomly divided into 2 equal groups, (n=20) each. Group (Ropi) received epidural 2 mg/kg 0.25 % ropivacaine and group (Bupi) received 2 mg/kg of bupivacaine at a concentration of 0.25% after induction of general anesthesia.The use of loss of resistance technique with a microdrip saline infusion method for identification of the epidural space was used in the current study and found to be safe, reliable and efficient.Ropivacaine had an onset of (9.6+2.4) minutes compared to (10.7+2.2) for the same dose of bupivacaine at a concentration of 0.25%.Postoperative, epidural infusion of 0.125% of either drug at a dose of 0.4 mg/kg/hr using an infusion pump for 24 hours was applied.There was no significant difference between the 2 groups in intraoperative and postoperative hemodynamic values; there was also no difference in the achieved level of sensory block or pain assessment by objective pain score, patients in both groups received no supplementary analgesics.Postoperative evaluation of motor block by modified Bromage scale showed ropivacaine to have significantly less motor block effects.Ropivacaine is a much safer local anesthetic than bupivacaine with less effect on motor power and similar potency. Therefore its use is recommended in pediatric lumbar epidural anesthesia for lower abdominal and orthopedic surgical procedures both intraoperative and for postoperative analgesia.

Issued

1 Jan 2003

Details

Type

Thesis

Created At

31 Jan 2023