Critical Aprraisal Journal

Judul : Comparison of levobupivacaine 0.25% and bupivacaine 0.25%for caudal

analgesia in children undergoing herniotomy

Penulis : P. A. Jadhav, A.D. Malde, Department of Anesthesia, Lokmanya Tilak

Municipal Medical College & General Hospital, Mumbai, India, Corresponding author: P. A.
Jadhav, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India

Publikasi : Pediatric Anesthesia and Critical Care Journal 2017;5(2):66-73

doi:10.14587/paccj.2017.11

Critical Aprraisal Worksheet

1. What is The Research Pertanyaan dari penelitian ini adalah untuk membandingkan
question and/or
efikasi, kendali motorik dan nyeri post operatif pada pasien post
hypothesis ?
operasi dengan caudal epidural menggunakan levobupivakain dan

bupivakain yang dapat kita lihat di bagian introduksi.

Menggunakan Bromage scale dan FLAAC score.

“Levobupivacaine is claimed to have less cardiotoxicity and

motor blockade. Our aim was to compare efficacy, motor

blockade and postoperative analgesia following caudal epidural

with either levobupivacaine or bupivacaine”

2. What is the Study Penelitian ini adalah jenis penelitian observasional dengan
Type ? clinical trial, yaitu dengan membandingkan levobupivakain
0.75ml/kg of 0.25% dan bupivakain 0.75ml/kg of 0.25%
 “After approval from the institutional research and ethics
committee and registering the trial with the Clinical Trial
Registry of India (CTRI No. CTRI/2014/06/004679), the
observational study was started”
3. What is the reference Populasi pada pasien ini adalah anak yang akan menjalani
population ? What are the prosedur pembedahan herniotomi ASA I dan II usia 3 bulan – 6
sampling frame and tahun. Ditetapkan 60 orang subjek penelitian namun tidak
sampling method ? dijelaskan proses sampling pasien.

“Informed written consent was obtained from the parents of 60

healthy children (American Society of Anesthesiologists Class
I& II) of either sex in the age group of 3 months to 6 years,
scheduled for elective herniotomy. Children with history of
previous surgeries requiring handling of spinal cord, any
neurological disorder, cardiac disease, pre-existing bleeding
disorder, hypersensitivityhypersensitivity to amide local
anaesthetic drugs, sacral abnormalities, and local infection,
were excluded from the study”
4. In an Experimental Subjek penelitian dipilih dengan kriteria inklusi dan dimasukkan
study, how were subject ke dalam grup serta menandatangani surat persetujuan. Tidak
assigned to group ? dijelaskan bagaimana proses samplingya, namun hanya terdapat
pengelompokan berdasarkan ASA yaitu ASA 1 dan ASA II

“Informed written consent was obtained from the parents of 60

healthy children (American Society of Anesthesiologists Class I
& II) of either sex in the age group of 3 months to 6 years,
scheduled for elective herniotomy”
5. What are the study Pada penelitian ini subjek penelitian dibagi dalam 2 grup, masing
factors and how are masing masing diberikan injeksi levobupivakaindan injeksi
they measured? bupivakain. Dan diukur dengan menggunakan alat Modified
Bromage dan FLACC score
 “Surgical incision was taken approximately 15 minutes after
the caudal block. Throughout the procedure vital parameters
including heart rate (HR), systolic blood pressure (SBP),
diastolic blood pressure (DBP), mean arterial pressure (MAP),
Oxygen saturation (SpO2) were monitored every 5 minutes till
awakening. Parameters noted just before the performance of
the caudal block were considered as the baseline parameters.
Caudal
block was considered ineffective if any two of the following
were present on application of forceps at the operative site: 1)
gross movements, 2) >20% increase in pulse rate, 3) >20%
increase in respiratory rate. At the end of surgery, supraglottic
device was removed in full awake patient with spontaneous and
regular respiratory pattern, capable of maintaining airway.
In the recovery room post-operatively motor blockade was
assessed at wake up, then every 15 minutes for one hour and
every 30 minutes for next hour. We used Modified Bromage
Scale for assessment. 0 – The patient is able to move hip, knee
and ankle, 1 – The patient is unable to move hip, but is able to
move knee and ankle, 2 – The patient is unable to move hip and
knee, but is able to move the ankle, 3 – The patient is unable to
move hip, knee and ankle. Significant residual motor block
was defined as a motor block score of > 1 at wake upand 180
minutes after caudal block.

6. What are the outcome Hasil penelitian menunjukkan bahwa secara statistik, pemberian
factor and how are levobupivakain sama efektifnya terutama dalam blok kaudal
they measured ? dibandingkan dengan bupivakain, sehingga dapat disimpulkan
levobupivakain merupakan pilihan yang terbaik.
 ”Our study confirms that 0.75 ml/kg 0.25% levobupivacaine
causes definitely less motor blockade compared to bupivacaine.
This is the most commonly used volume and concentration of
local anesthetic used for caudalepidural analgesia for
herniotomy. Although a moderate degree of residual blockade
is not a major problem, inability to communicate the same in
nonverbal children leads to agitation and excessive crying. This
can become a cause of parental anxiety also. In addition to this
it isalways advisable to discharge a patient who is free of
motor blockade in a day care setting.”
7. What important Potensial Co-Founder pada penelitian ini adalah
potential cofounders - Jenis Kelamin
are considered ? - Data hemodinamik (HR, TD, MAP) diukur pada menit 5
,dan 10 menit
Semua Potensial Co-Founder diperhitungkan secara statistik
pada penelitian ini.

“Throughout the procedure vital parameters including heart

rate (HR), systolic blood pressure (SBP), diastolic blood
pressure (DBP), mean arterial pressure (MAP), Oxygen
saturation (SpO2) were monitored every 5 minutes till
awakening. Parameters noted just before the performance of
the caudal block were considered as the baseline parameters”
8. Are statistical test Ya , hasil statistik dipertimbangkan , dengan level signifikansi
considered ? pada test ini dipertimbangkan sebesar 0,05. Data diolah dengan
IBM SPSS menggunakan Chi-Square test.

“The quantitative data like demographic profile, duration of

surgery and anesthesia, hemodynamic parameters and FLACC
score were analyzed using Unpaired Students‘t’ test.
Qualitative data like caudal block efficacy, postoperative motor
 blockade and rescue analgesia requirement was assessed using
Chi X2 test. For all the parameters, P < 0.05 was considered to
be significant”
9. Are the result Ya . hasil penelitian menunjukkan bahwa secara statistik, yaitu
clinically important ? levobupivakain dapat dipertimbangkan digunakan untuk
analgesia epidural.

“To conclude levobupivacaine results in equally effective

10. What Conclusion did
the author reach about
the research question ?
Did they generate new
hypotheses ? Do you
agree with the
conclution ?
caudal block providing satisfactory perioperative analgesia
comparative to bupivacaine with an additional advantage
of less residual motor blockade. Levobupivacaine 0.25%
0.75ml/kg is a better choice compared to bupivacaine for
caudal analgesia for herniotomy in children”
- Hasil penelitian menunjukkan bahwa secara statistik,
pemberian levobupivakain sama efektifnya terutama dalam
blok kaudal dibandingkan dengan bupivakain, sehingga dapat
disimpulkan levobupivakain merupakan pilihan yang terbaik.
- Tidak terdapat hipotesis baru yang dibuat oleh peneliti
- Saya setuju dengan hasil penelitian dalam jurnal ini , namun
dibutuhkan studi lebih lanjut untuk melengkapi jurnal ini.

“To conclude levobupivacaine results in equally effective

caudal block providing satisfactory perioperative analgesia
comparative to bupivacaine with an additional advantage of
less residual motor blockade.
Levobupivacaine 0.25% 0.75ml/kg is a better choice compared
to bupivacaine for caudal analgesia for herniotomy in
children”