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The median effective concentration of ropivacaine for ultrasound-guided caudal block in children: a dose-finding study

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Abstract

Purpose

To determine the 50% minimum effective concentration (MEC50) and the 95% effective concentration (MEC95) of ropivacaine for ultrasound-guided caudal block during hypospadias repair surgery of pediatric patients.

Methods

Children were enrolled with the American Society of Anesthesiologists (ASA) physical status I–II undergoing elective hypospadias repair surgery. Children were grouped into two age groups: toddlerhood (1–3 years old) and preschool (3–6 years old). We measured The MEC50 using Dixon’s up-and-down method. The first children received the caudal block with 1.0 mL/kg of 0.15% ropivacaine. We determined each subsequent patient’s concentration based on the previous patient’s response and adjusted the concentration in intervals of 0.015%. Meanwhile, the probit regression analysis obtains 95% effective concentration (MEC95). In addition, we recorded the general condition, adverse events, and postoperative pain of each child.

Results

46 children undergoing elective hypospadias repair surgery were included in this study, 22 in the toddlerhood group and 24 in the preschool group. Of the total number of patients, the caudal block was successful in 25 (54%) and failed in 21 (46%). The MEC50 of 1 ml/kg ropivacaine was 0.102% (95% CI 0.099%, 0.138%) in the toddlerhood group and 0.129% (95% CI 0.124%, 0.138%) in the preschool group. The MEC95 of 1 ml/kg ropivacaine was 0.148% (95% CI 0.131%, 0.149%) in the toddlerhood group and 0.162% (95% CI 0.134%, 0.164%) in the preschool group. Our results showed that ropivacaine concentration was statistically different between preschool children and toddlers (P < 0.001). None of the adverse events occurred.

Conclusions

This study showed that children in the preschool group required higher concentrations of ropivacaine than children in the toddler group during ultrasound-guided sacral block combined with non-intubated general anesthesia. At the same time, this method of anesthesia is safe and effective for children undergoing surgery for hypospadias.

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Data availability

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

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Acknowledgements

Assistance with the article: We would like to thank all staff from the Anesthesia Department and Urology Department at the Children’s Hospital affiliated with Chongqing Medical University, China, for their help with this article.

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Authors and Affiliations

  1. Department of Anaesthesiology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, No.136, Second Zhongshan Road, Yuzhong District, Chongqing, 400014, China

    Yaqiong Tian, Shangyingying Li, Fei Yang, Li Yang, Ling Liu, Wen Gao & Shengfen Tu

  2. Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China

    Ling Liu, Wen Gao & Shengfen Tu

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  1. Yaqiong Tian
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  2. Shangyingying Li
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  3. Fei Yang
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  4. Li Yang
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  5. Ling Liu
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Correspondence to Shengfen Tu.

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Tian, Y., Li, S., Yang, F. et al. The median effective concentration of ropivacaine for ultrasound-guided caudal block in children: a dose-finding study. J Anesth 38, 179–184 (2024). https://doi.org/10.1007/s00540-023-03294-1

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  • DOI: https://doi.org/10.1007/s00540-023-03294-1

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