A comparison of two different doses of bupivacaine in caudal anesthesia for
neonatal circumcision. A randomized clinical trial.
Author(s): Bilgen S(1), Koner O, Menda F, Karacay S, Kaspar EC, Sozubir S.
Affiliation(s): Author information:
(1)Yeditepe University Hospital, Anesthesiology Department, Istanbul Turkey.
sevgibilgen@yahoo.com
Publication date & source: 2013, Middle East J Anaesthesiol. , 22(1):93-8
BACKGROUND: We aimed to compare the analgesia quality of caudal block of low
volume, high concentration bupivacaine to the conventionally used volumes and
concentrations of the drug in neonates undergoing circumcision with sole caudal
anesthesia.
METHODS: Fifty neonates, undergoing circumcision were randomly assigned to low
volume high concentration (group LVHC, n=25) and control groups (group C, n=25).
Both groups received a caudal injection: Group LVHC 0.5 ml/kg bupivacaine 0.375%
(1.875 mg/kg) and group C 1 ml/ kg bupivacaine 0.25% (2.5 mg/kg). Hemodynamic
parameters, block onsets and analgesia periods were compared among the groups.
Pain scores were evaluated hourly for 3 hours postoperatively with NIPS (neonatal
infant pain score). Statistical analyses were performed with Student's t-test for
continuous variables. X(2) and Mann-Whitney U-tests were used for nominal and/or
categorical variables.
RESULTS: Demographic, hemodynamic data, block onset time (group LVHC and C values
were 4.9 +/- 1 vs 5.2 +/- 2 mins, respectively; p=0.53) was similar and
postoperative median NIPS (a median value of 0 at postoperative 1, 2, and 3.
hours) were identical among the groups (p=0.7, p=0.9, p=1). None of the neonates
required additional analgesic for the first 24 hours following the surgery;
therefore postoperative analgesic requirement was similar among the groups
(p>0.1).
CONCLUSIONS: Low volume high concentration caudal bupivacaine provided a similar
perioperative analgesia quality, time and safety profile compared to conventional
bupivacaine doses in awake neonates undergoing circumcision. Low volume, high
concentration bupivacaine may be used to reduce the risk of local anesthetic
toxicity in outpatient neonates.
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