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Efficacy of caudal levopubivacaine versus bupivacaine in children undergoing lower abdominal surgery: a prospective randomized controlled study

Background Postoperative pain in pediatrics causes psychological and physiological problems; thus, preemptive analgesia is important, even in newborns. Caudal block is a useful adjuvant with general anesthesia and for postoperative analgesia for infraumbilical operations. Levobupivacaine is less cardiotoxic, less neurotoxic, and an equally potent local anesthetic compared with its racemate. Aim Our aim is to compare the efficacy of caudally administered isobaric levobupivacaine 0.25% versus isobaric bupivacaine 0.25% in children undergoing lower abdominal surgery. Patients and methods This study was carried out on 60 children, 1–10 years, American Society of Anesthesiologists I–II, scheduled for elective lower abdominal surgery. Patients were randomized into two equal groups (30 patients in each group): group I: bupivacaine group: patients received 1 ml/kg bupivacaine 0.25%. Group II: levobupivacaine group: patients received 1 ml/kg levobupivacaine 0.25%. The onset time of sensory block, heart rate, mean arterial blood pressure, and respiratory rate were recorded intraoperatively. Postoperative pain was assessed using the Children’s and Infant’s Postoperative Pain Scale; time of postoperative first rescue of analgesia and duration of motor blockade were determined by the Bromage score postoperatively. Results There was no significant difference between both groups in the onset time of sensory block, hemodynamics (heart rate and mean arterial pressure), and respiratory rate. Children’s and Infant’s Postoperative Pain Scale was significantly lower in group I at 120 and 180 min postoperatively. The Bromage score was significantly lower in group ІІ at 15, 30, and 60 min postoperatively. Time till administration of first-rescue analgesia was significantly shorter in group II than group I. Conclusion Using similar doses, bupivacaine produced a higher incidence of residual motor block and longer analgesic block than levobupivacaine. Thus, levobupivacaine is more suitable for short operations and could make it preferable for day case surgery. However, bupivacaine is still more suitable for prolonged operations.