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BJA Advance Access published online on June 19, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael145
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted May 1, 2006

Clinical Investigation

Efficacy and plasma levels of ropivacaine for children: controlled regional analgesia following lower limb surgery

F. Duflo 1 *, V. Sautou-Miranda 2, A. Pouyau 1, P. Taylor 1, S. Combet 1, F. Chotel 3, N. Bleyzac 4, and D. Chassard 1

1 Département d'Anesthésie-Réanimation, Hôpital Debrousse, Lyon, France
2 Service Pharmacie, Hôpital Montpied, Clermont-Ferrand, France
3 Département de Chirurgie Infantile Orthopédique, Hôpital Debrousse, Lyon, France
4 Département de Pharmacologie Clinique Hôpital Debrousse, Lyon, France

* To whom correspondence should be addressed.
F. Duflo, E-mail: frederic.duflo{at}chu-lyon.fr


  Abstract

Background. Continuous regional analgesia (CRA) is considered a safe and efficacious technique for postoperative pain relief in children after lower limb surgery. We recently evaluated the feasibility of patient-controlled regional analgesia (PCRA) in a similar acute pain situation and we concluded that PCRA might be advantageous over CRA in terms of lower costs, risk of systemic toxicity while producing similarly adequate analgesia. We therefore prospectively compared both techniques in the paediatric population.

Methods. In total, 30 children undergoing lower limb orthopaedic surgery were randomized to receive PCRA or CRA with ropivacaine 0.2%. Visual analogue scale scores, rescue analgesia, overall satisfaction, motor blockade and plasma ropivacaine concentrations were recorded for 48 h.

Results. Adequate analgesia was achieved with both techniques. No significant difference was noted for rescue analgesia, overall satisfaction and motor blockade. In contrast, children in the PCRA group received significantly less local anaesthetics than those in the CRA group. In addition, total plasma concentrations of ropivacaine were significantly reduced in the PCRA group as compared with the CRA group during the 48 h postoperative period.

Conclusions. Both techniques are efficacious and satisfactory. However, PCRA with ropivacaine 0.2% can provide adequate postoperative analgesia for paediatric orthopaedic procedures with smaller doses of ropivacaine than CRA.

Keywords: anaesthetics local, ropivacaine; analgesia, regional; children; pain, postoperative.
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