New local anesthetics for pediatric anesthesia

Current Opinion in Anaesthesiology
Pasquale De NegriAnna Claudia Del Piano

Abstract

To evaluate the relevance of new local anesthetics in pediatric regional anesthesia. Several studies evaluate the pharmacokinetics of new local anesthetics, like ropivacaine and levobupivacaine, and compare their safety and efficacy with the old but widely used bupivacaine. The goal of anesthetists using regional anesthesia is to use local anesthestics that are as safe and effective as possible, with a rapid onset and a long duration. Even though adequate dose guidelines are available, several toxic effects are reported with the use of bupivacaine in children due to inadvertent intravenous injection, long-term infusion (> 48 h) or administration in newborn babies and infants with reduced metabolism. Ropivacaine and levobupivacaine are new local anesthetics with a wider safety margin that have similar characteristics: both of them are pure S-(-)-enantiomers whose main pharmacological features are less cardio- and neuro-affinity and -toxicity in comparison with the racemic formulae and R-isomers, and a differential neural blockade with less motor than sensory block. Several clinical studies in children compare ropivacaine and levobupivacaine with bupivacaine.

References

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Nov 24, 2004·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Wolfgang Zink, Bernhard M Graf

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Citations

Oct 5, 2011·Anesthesiology Research and Practice·Sarah Ciechanowicz, Vinod Patil
Aug 18, 2006·Annales Françaises D'anesthèsie Et De Rèanimation·S RoulletF Semjen
Mar 10, 2012·British Dental Journal·S J CiechanowiczUNKNOWN Association of Anaesthetists of Great Britain and Ireland
Feb 10, 2011·Anesthesia and Analgesia·Marcio G KiuchiRoberto T Sudo

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