Levobupivacaine – Dosing Scheme in Paediatric Anaesthesia

Overview

Regional anaesthesia is increasingly used in combined anaesthesia and for continuous postoperative analgesia. Next tobupivacaine, its levorotatory enantiomer – levobupivacaine – has been recently used more frequently. The efficacy of thisnew local anaesthetic drug is comparable with that of bupivacaine, however, its neurotoxicity and cardiotoxicity aresignificantly lower. Therefore, levobupivacaine seems to be a suitable anaesthetic drug for newborn babies and smallchildren in which, in case of inaccurate administration, the risk of fatal complication is quite high. In the article we presenta survey of dosage of levobupivacaine for paediatric patients. These data have only been sporadically reported so far.Drawn-up survey of dosage of levobupivacaine has been based on evaluation of data available in literature and our ownexperience. Maximum single dose for caudal and lumbar block is 2 mg/kg and 1.25 mg/kg for thoracic block.The continuousregimen dosage is based on the following scheme: 0.2 mg/kg/hour for newborns and 0.3–0.4 mg/kg/hour for older children.The citied authors differ slightly in doses and concentrations of the local anaesthetic used for the respective levels of accessinto the epidural space. The opinion prevails that administration of levobupivacaine to children of all age categories is basedon approved indications for bupivacaine.

Key words:
regional anaesthesia of children – levobupivacaine – cardiotoxicity – neurotoxicity – dosage of levobupivacainein children