Ropivacaine with Fentanyl versus Bupivacaine with Fentanyl for Caudal Epidural in Pediatric Infraumbilical Surgeries – A Prospective Randomized Double-blinded Trial

Background: Caudal epidural block is widely used in the pediatric age group. This study aims to determine that ropivacaine with fentanyl provides a shorter duration of motor blockade than the comparable sensory blockade, which can be used as an effective alternative to bupivacaine in caudal epidural anesthesia. Objective: The objective of this study was to assess the efficacy of ropivacaine versus bupivacaine when combined with fentanyl in single-shot caudal epidural anesthesia in pediatric infraumbilical surgeries in terms of time taken for motor regression. Subjects and Methods: This was a prospective randomized double blinded study done among the pediatric population of 1-12years, undergoing infraumbilical surgeries under general anaesthesia. Efficacy of caudal epidural anaesthesia assessed with fentanyl+bupivacaine 30 patients (50%) and fentanyl+ ropivocaine 30 patients (50%). Group 1 received 0.25% of 0.7 mL/kg bupivacaine + 1 μg/kg of fentanyl with normal saline in a caudal epidural. Group 2 received 0.25% of 0.7 mL/kg ropivacaine + 1 μg/kg of fentanyl with normal saline in a caudal epidural. The demographic details and anthropometry were compared. The hemodynamic parameters were compared both intraoperatively and postoperatively. Bromage scale and Face, Legs, Activity, Cry, and Consolability pain score were compared postoperatively between both the groups. Results: The hemodynamic parameters, sedation, and pain were not statistically different between the groups. Among the bupivacaine group, there was a statistically significant, higher Bromage scale (P = 0.001), decreased time to rescue analgesia (P = 0.001), and higher duration of motor blockade (P = 0.001). Conclusion: We conclude that ropivacaine (0.25%) with fentanyl provides less intense motor nerve blockade with a shorter duration of analgesia, hence facilitating early ambulation.