Comparison of Levobupivacaine and Bupivacaine in Caudal Epidural by Ultrasound for Postoperative Analgesia in Children

Background: Effective post-operative pain management is critical in pediatric patients following infraumbilical surgeries. While landmark-guided caudal blocks are common, ultrasound guidance enhances safety and precision. This hospital-based, prospective, randomized, double-blinded study compares the duration of analgesia, hemodynamic stability, and motor recovery of 0.25% bupivacaine versus 0.25% levobupivacaine in pediatric caudal epidurals. Ninety-two children (ASA I-II, aged 2–8 years) undergoing elective infraumbilical surgeries were allocated into two equal groups (n=46) to receive either 0.25% bupivacaine or 0.25% levobupivacaine under ultrasound guidance. The primary outcome assessed was the duration of analgesia, while secondary outcomes included hemodynamic parameters, FLACC pain scores, and the time to motor recovery as assessed by the Modified Bromage Scale. The mean duration of analgesia was significantly longer in the bupivacaine group (329.28 ± 22.69 mins) compared to the levobupivacaine group (286.85 ± 13.96 mins) (p < 0.001). Conversely, motor recovery was significantly faster with levobupivacaine (3.20 ± 0.66 hours) than with bupivacaine (4.07 ± 0.85 hours) (p < 0.001). Intraoperative heart rates were slightly lower in the bupivacaine group, but postoperative hemodynamics and adverse effects were minimal and comparable across both groups. While levobupivacaine offers faster motor recovery, bupivacaine provides a significantly longer duration of postoperative analgesia. When performed under ultrasound guidance, which effectively mitigates the risk of inadvertent intravascular injection, bupivacaine remains an excellent, safe choice for maximizing the pain-free window in pediatric day-care surgeries.

Keywords: Bupivacaine; Caudal epidural; Levobupivacaine; Paediatric analgesia; Ultrasound guidance.