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A comparison of high volume/low concentration and low volume/high concentration ropivacaine in caudal analgesia for pediatric orchiopexy

 Jeong-Yeon Hong  ;  Sang W. Han  ;  Won O. Kim  ;  Jin S. Cho  ;  Hae K. Kil 
 ANESTHESIA AND ANALGESIA, Vol.109(4) : 1073-1078, 2009 
Journal Title
Issue Date
Acetaminophen/administration & dosage ; Administration, Oral ; Ambulatory Surgical Procedures* ; Amides/administration & dosage* ; Amides/adverse effects ; Analgesics, Non-Narcotic/administration & dosage ; Anesthesia Recovery Period ; Anesthesia, Caudal/methods* ; Anesthetics, Local/administration & dosage* ; Anesthetics, Local/adverse effects ; Child, Preschool ; Humans ; Infant ; Male ; Pain Measurement ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control* ; Prospective Studies ; Testis/innervation ; Testis/surgery* ; Time Factors ; Treatment Outcome ; Urologic Surgical Procedures, Male*
BACKGROUND: It is unclear whether the volume or concentration of local anesthetic influences its spread and quality of caudal analgesia when the total drug dose is fixed. METHODS: We performed this study in a prospective, randomized, observer-blind manner. Children aged 1-5 yr received a constant dose of 2.25 mg/kg of ropivacaine prepared as either 1.0 mL/kg of 0.225% (low volume/high concentration [LVHC], n = 37) or 1.5 mL/kg of 0.15% solution (high volume/low concentration [HVLC], n = 36). Both solutions contained radiopaque dye. RESULTS: The median spread levels with ranges in the HVLC group (confirmed by fluoroscopic examination) were significantly higher (T6, T3-11) than in the LVHC group (T11, T8-L2). There were no significant differences in recovery times, postoperative pain scores, or side effects between the two groups. After discharge, fewer children in the HVLC group required rescue oral acetaminophen compared with the LVHC group (50.0% vs 75.7%). First oral acetaminophen time was found to be significantly longer with HVLC patients than LVHC patients (363.0 min vs 554.5 min). CONCLUSIONS: We confirmed (with fluoroscopy) that a caudal block with 1 mL/kg ropivacaine spreads to T11 and to T6 with 1.5 mL/kg. If the total dose is fixed, caudal analgesia with a larger volume of diluted ropivacaine (0.15%) provides better quality and longer duration after discharge than a smaller volume of more concentrated ropivacaine (0.225%) in children undergoing day-case orchiopexy. The spread level of ropivacaine correlated significantly with the first oral acetaminophen time after discharge.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kil, Hae Keum(길혜금)
Kim, Won Oak(김원옥)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
Hong, Jeong Yeon(홍정연)
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