Bupivacaine toxicity secondary to continuous caudal epidural infusion in children.

egional anesthesia has become an integral part of the intraoperative anesthetic management R of children (1,2). The success of nerve blocks and “kiddie caudals” in managing surgical stress has also led to the use of these techniques in alleviating postoperative pain (2-5). In many instances, bupivacaine is the local anesthetic chosen for these techniques because of its longer duration of action and greater sensory versus motor blockade at a given therapeutic dose (6,7). A safe and effective bolus dose for caudal injection, based on pharmacokinetic and pharmacodynamic studies, has been determined for infants and children (8-10); however, the pharmacokinetic and pharmacodynamic properties of prolonged continuous caudal epidural bupivacaine infusions in children have not been investigated. We present three case reports to illustrate that prolonged infusions of bupivacaine by the caudal route can lead to systemic toxicity.

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