RESUMO
OBJETIVOS: Se compara levobupivacaína versus bupivacaínaen niños para analgesia epidural torácica oabdominal alta. Hipótesis: levobupivacaína se comportade igual modo que bupivacaína a dosis equivalentes.MATERIALY MÉTODOS: Pacientes distribuidos aleatoriamenteen Grupo I (levobupivacaína) y Grupo II (bupivacaína),ASA I-IV, entre 5-16 años. Tras anestesia general, se colocócatéter epidural torácico o lumbar alto; administramos boloanestésico epidural de bupivacaína versus levobupivacaína0,25% (1 mg kg1), manteniéndose anestesia general. Realizamosanalgesia con perfusión epidural de bupivacaína o levobupivacaína0,125% con fentanilo, y rescate con fentaniloperioperatorio, y metamizol magnésico postoperatorio. Se disminuyóla perfusión epidural un 25% cada día desde el 2º día.Se analizó: perfil hemodinámico y respiratorio; analgesia derescate; tiempos para extubación y alta de Reanimación, complicacionesde la técnica, efectos adversos y confort obtenido.RESULTADOS: Estudiamos 64 pacientes, Grupo I (n = 33)y Grupo II (n = 31). Diferencias significativas en: estanciaen Reanimación (p < 0,05), mayor para Grupo II (4,2 ± 0,99días) que para Grupo I (3,5 ± 0,6 días); analgesia de rescateperioperatoria (p < 0,01), Grupo I mayor que Grupo II[n = 6 (18,18%) y n = 3 (9,67%)]; analgesia de rescate postoperatoria(p < 0,01), Grupo I menor que Grupo II a partirde las 48 h. Bloqueo motor (p < 0,05), Grupo II mayorque Grupo I. Los efectos adversos y las complicaciones fueron,dos bradicardias persistentes y una punción dural sinmanifestaciones clínicas posteriores.CONCLUSIONES: En nuestra experiencia en anestesia epiduraltorácica y abdominal alta, levobupivacaína tiene unperfil muy parecido a bupivacaína racémica. Levobupivacaína,menos tóxica, podría sustituir a bupivacaína en niños
OBJECTIVES: We compared levobupivacaine to bupivacaine for epidural analgesia for thoracic or upper abdominal surgery in children. Our working hypothesis was that at equivalent doses levobupivacaine and bupivacaine behave in the same way. MATERIALAND METHODS: ASA1-4 patients between the ages of 5 and 16 years were randomized to a levobupivacaine or a bupivacaine group. After general anesthesia was induced, we inserted a thoracic or upper lumbar epidural catheter and administered a dose of 0.25% bupivacaine or levobupivacaine (1 mg·kg-1) while maintaining general anesthesia. Analgesia was provided with an epidural infusion of 0.125% bupivacaine or levobupivacaine with fentanyl. Fentanyl was used as a perioperative rescue analgesic and metamizole magnesium as a postoperative rescue analgesic. The epidural infusion was reduced by 25% each day beginning on the second day. We analyzed hemodynamic and respiratory variables, rescue analgesia, time until extubation and discharge from the recovery unit, complications associated with the technique, adverse effects, and degree of comfort achieved. RESULTS: We studied 64 patients; 33 received levobupivacaine and 31 bupivacaine. Mean (SD) duration of recovery unit stay was significantly longer in the bupivacaine group (4.2 [0.99] days) than in the levobupivacaine group (3.5 [0.6] days; P<.05). Significantly more patients needed perioperative rescue analgesia in the levobupivacaine group (n=6 [18.18%]) than in the bupivacaine group (n=3 [9.67%]; P<.01). After 48 hours, the need for postoperative rescue analgesia was significantly lower with levobupivacaine (P<.01). Motor block was significantly greater with bupivacaine (P<.05). Adverse effects and complications included 2 cases of persistent bradycardia and 1 case of dural puncture with no subsequent clinical manifestations. CONCLUSIONS: This experience with epidural anesthesia for thoracic and upper abdominal surgery showed levobupivacaine and racemic bupivacaine to have similar profiles. Levobupivacaine, which is less toxic, could be used to replace bupivacaine in children
