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Ropivacaine in infants and children.
MedLine Citation:
PMID:  17021475     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Ropivacaine is considered less toxic than bupivacaine. In addition, at the low concentrations used for providing postoperative analgesia, ropivacaine seems to produce less motor blockade than bupivacaine. These two properties are of particular interest in paediatric practice. RECENT FINDINGS: In paediatric practice regional anaesthesia is usually performed under general anaesthesia, and postoperative analgesia was until recently the major concern for most practitioners. The question now is: what is the right concentration to provide adequate intraoperative anaesthesia when ropivacaine is used in combination with volatile anaesthetic agents? The low concentration of ropivacaine used for postoperative analgesia seems to provide adequate intraoperative anaesthesia when general anaesthesia with a 0.5 minimum concentration of volatile anaesthetic is used in combination. However, potential toxicity is still the subject of debate because ropivacaine clearance is low in infancy and early childhood. Ropivacaine has a longer absorption process than bupivacaine, which leads to a lower maximum peak concentration with ropivacaine than with bupivacaine either after central or peripheral blocks, thus increasing the safety of the drug. The addition of adjuvant drugs also permits lower concentrations of ropivacaine, while providing excellent analgesia. The addition of adrenaline at very low concentrations has recently been found to increase the quality of epidural analgesia. SUMMARY: Ropivacaine is now the reference drug for regional anaesthesia in paediatric patients, mainly because it is considered less toxic than bupivacaine and provides excellent postoperative analgesia even when used at low concentrations.
Authors:
Jean-Xavier Mazoit; Bernard J Dalens
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current opinion in anaesthesiology     Volume:  16     ISSN:  0952-7907     ISO Abbreviation:  Curr Opin Anaesthesiol     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2006-10-05     Completed Date:  2007-06-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8813436     Medline TA:  Curr Opin Anaesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  305-7     Citation Subset:  -    
Affiliation:
Departement d'Anesthésie et Réanimation, Hôpital Bicêtre, UPRES EA 3540, Université Paris-Sud, Faculté de Médecine du Kremlin-Bicêtre, F-94275 Le Kremlin-Bicêtre, France. Jean-Xavier.Mazoit@kb.u-psud.fr
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