Comparison of block characteristics of intrathecal isobaric levobupivacaine versus isobaric ropivacaine for infra-umbilical surgeries in school-age children: A prospective randomised double-blind study

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Background and Aims: Levobupivacaine and ropivacaine are effective local anaesthetic drugs used in regional anaesthesia with low cardio-neurotoxicity profile than bupivacaine, but comparative studies are limited in children. So, we compared these two drugs intrathecally to study their efficacy and safety in school-age children. Methods: This study was carried out in 60 American Society of Anesthesiologists class I, II and III patients aged 6–12 years, of either sex undergoing infra-umbilical surgeries. After institutional ethical committee approval and written informed consent, the patients were randomly divided into two groups. Group A received isobaric levobupivacaine (0.5%, 0.3-0.4 mg/kg), whereas group B received isobaric ropivacaine (0.5%, 0.5 mg/kg) intrathecally. Fentanyl (0.2 μg/kg) was used as an adjuvant in both the groups. Onset, peak and duration of sensory and motor blockade, duration of post-operative analgesia, time for micturition, perioperative haemodynamic parameters and complications were compared. Results: Onset and peak of sensory and motor block were earlier in group A. Significantly longer duration of sensory and motor block was achieved in group A (251 ± 41 min, 201 ± 40 min) compared to group B (211 ± 21 min, 102 ± 16 min) ( P < 0.001). The time to first rescue analgesic was also significantly prolonged in group A (270 ± 39 min) compared to group B (233 ± 18 min) ( P < 0.001). Time to micturition was much early in group B (157 ± 27 min) compared to group A (225 ± 31 min) ( P < 0.001). Conclusion: Intrathecal isobaric levobupivacaine and ropivacaine with fentanyl produces effective surgical anaesthesia and postoperative analgesia without any adverse effects. Early regression of sensorimotor blockade makes ropivacaine better in comparison to levobupivacaine for short infra-umbilical surgeries in children.

Ropivacaine may suit short pediatric spinals for quicker recovery; leaves open optimal use pending larger confirmatory trials.