Comparing the Anaesthetic and Analgesic Efficacy of Caudal Levobupivacaine and Ropivacaine in Paediatric Patients

Introduction: Introduction of S enantiomer of bupivacaine is a major breakthrough in the history of local anaesthesia as the pharmacodynamics of these drugs were favourable in reducing the occurrence of cardiotoxicity, neurotoxicity and unintended motor blockade Aim: To compare efficacy, postoperative analgesia and postoperative motor blockade of 0.25% levobupivacaine with 0.25% ropivacaine in caudal block for children, scheduled for lower abdominal and lowerlimb surgeries. Materials and Methods: 80 children, ASA I-II, 1-10 years, weighing between 5-30 kg, scheduled for elective lower abdominal and lower limb surgeries were given single caudal injection of 1 mL/kg of either levobupivacaine or ropivacaine. Caudal block was given after general anaesthesia using sevoflurane as induction agent airway secured with laryngeal mask. Postoperative pain score was assessed using Children and Infants Postoperative Pain Scale (CHIPPS) scale in children less than 6 years and numerical scale for children more than 6 years. Motor recovery was assessed by modified Bromage scale. Results: Onset of analgesia, duration of analgesia, postoperative pain and motor blockade were comparable between the two groups, of 40 each. Analgesia time was within 5 minutes in both the groups. Duration of analgesia was 404.8 +/- 67.6 minutes for levobupivacaine and 413.5 +/- 44.4 minutes for ropivacaine, which was not significant statistically. Postoperative analgesia was same between the two groups. It took 120 minutes for complete postoperative motor recovery. The motor recovery between the two groups was statistically not significant at immediate postoperative period (p=0.111), at 60 minutes (p=0.692). Conclusion: We conclude that both 1 mL of 0.25% levobupivacaine and 0.25% ropivacaine provide similar effect caudal anaesthesia and analgesia with motor blockade for 120 minutes.