Caudal anaesthesia in paediatric patients

The caudal canal in children: a study using magnetic resonance imaging

“…In infants the sacrum is a triangular bone formed by the fusion of the five sacral vertebrae. Ossification of the vertebral arches remains incomplete until the age of 8 years, when they unite with each other and with the vertebral bodies (8). The sarcral hiatus is formed by the nonfusion of the fifth sacral vertebral arch and is covered by the sacrococcygeal membrane.…”

A comparative study of caudal epidural anaesthesia versus general anaesthesia for lower abdominal and lower limb surgery in paediatric patients

“…1 Caudal anaesthesia can be given as single injection or continuous infusion. But in pediatric patients, as volume of sacral canal is small, catheter insertion for continuous technique can lead to trauma.…”

Analgesia pós-operatória em pacientes pediátricos: estudo comparativo entre anestésico local, opióides e antiinflamatório não esteróide

“…As dificuldades na avaliação da dor em crianças foram, em parte, responsáveis por condutas recentes, preconizadas por Ecoffey 15 , sugerindo que técnicas de analgesia sejam administradas antes do despertar da anestesia e sempre que possível evitadas injeções intramusculares ou subcutâneas. A via peridural caudal, em crianças, é muito adequada para administração de agentes analgésicos e vários trabalhos já foram realizados utilizando anestésicos locais, especialmente a bupivacaína, com resultados bastante satisfatórios [16][17][18][19][20][21][22][23][24][25][26] . Procedimentos cirúrgicos mais complexos e com tempo prolongado têm exigido técnicas de analgesia mais efetivas e duradouras, e o uso de opióides, por via peridural caudal, inicialmente com a morfina, tornou-se uma opção para crianças, do mesmo modo que vinha sendo realizado em adultos [27][28][29][30][31][32][33][34] .…”

“…Difficulties in evaluating pediatric pain were partially responsible for recent approaches suggested by Ecoffey 15 , who suggests that analgesia should be administered before emergence and that muscular or subcutaneous injections should be avoided whenever possible. Epidural caudal administration in children is very adequate for analgesics administration and several studies were carried out using local anesthetics, especially bupivacaine, with satisfactory results [16][17][18][19][20][21][22][23][24][25][26] . Complex and prolonged surgical procedures have required more effective and long-lasting analgesic techniques and epidural caudal opioids, initially morphine, have become an option to children, similarly to what has been used to adults [27][28][29][30][31][32][33][34] .…”