• Giorgio Ivani, Pasquale DeNegri, Alessandra Conio, Roberto Grossetti, Pasquale Vitale, Claudia Vercellino, Ferdinando Gagliardi, Staffan Eksborg, and Per-Arne Lonnqvist.
• Department of Anesthesiology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy. gioivani@libero.it
• Reg Anesth Pain Med. 2002 Mar 1; 27 (2): 157-61.

Background And ObjectivesTo compare ropivacaine, levo-bupivacaine, and racemic bupivacaine for caudal blockade in children.MethodsUsing a prospective observer blinded design, 60 sevoflurane anesthetized children (1 to 7 years) undergoing minor subumbilical surgery, were randomized to receive a caudal block (1 mL/kg) with either ropivacaine 0.2%, racemic bupivacaine 0.25%, or levo-bupivacaine 0.25%. Postoperative analgesia (number of patients needing supplemental analgesia as defined by an objective pain score [OPS] score of > or = 5; time to first analgesic demand) during the first 24 postoperative hours was chosen as the primary end-point. Early postoperative motor block (3-point scale) was assessed as a secondary end-point.ResultsAll blocks were judged to be clinically successful based on the presence of adequate intraoperative and early postoperative analgesia. An OPS score > or = 5 was found in 5/20 patients in each study group. No difference regarding the time to first analgesic demand was found between the study groups. The use of ropivacaine (P =.02), but not levo-bupivacaine (P =.18), was found to be associated with less motor block during the first postoperative hour compared with racemic bupivacaine.ConclusionAll 3 investigated local anesthetics were found to be clinically comparable despite the slight reduction of early postoperative motor block associated with the use of ropivacaine.

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