Caudal analgesia and anesthesia techniques in children

Abstract

The addition of ketamine or clonidine to a caudal local anesthetic prolong the duration of the block. However, a preservative-free preparation of ketamine that is suitable for neuraxial use is not widely available. Ultrasound imaging and electrical stimulation are promising options to accurately position a caudal needle. However, because ultrasound imaging is more difficult in older children, nerve stimulation is a more-suitable technique to accurately guide caudal catheters in this patient population. Although complications associated with caudal block are rare, the risks and benefits must be carefully considered on an individual basis.

Comparative Study of Caudal Ropivacaine and Ropivacaine - Clonidine Combination in Paediatric Urogenital Surgeries for Post - Operative Analgesia

“…6 This study has been carried out to compare the efficacy of caudal block with ropivacaine and ropivacaine with clonidine combination in paediatric urogenital surgeries:…”

Innovative Approaches to Neuraxial Blockade in Children: The Introduction of Epidural Nerve Root Stimulation and Ultrasound Guidance for Epidural Catheter Placement

“…Perhaps now, with the introduction of the stimulation catheter and portable ultrasound machines, anesthesiologists may have reliable tools not only to confirm catheter placement in the epidural space, but also to accurately determine where the catheter tip is in the central neuraxis. Apart from improving efficacy and safety, these techniques will also be valuable for training purposes (1). Although there has been a great deal of progress in the development of epidural techniques, there is still no evidence that direct thoracic epidural placement can be performed without risk.…”

“…However, while fluoroscopy permits continuous real-time monitoring and adjustment of advancing catheters, it requires additional set-up, incurs increased expense and, more importantly, increases the patient's exposure to ionizing radiation (1). As a result, fluoroscopy is commonly avoided for routine use and is usually limited to difficult and/or special circumstances such as chronic epidural catheter placement.…”

“…Particularly for pediatric patients, accurate segmental localization is important for avoiding local anesthetic toxicity and side effects through maximizing effect with minimal doses. Single-shot epidural blocks are associated with limited duration and segmental effects, and continuous epidural anesthesia has become popular to overcome these limitations (1). The standard for epidural needle localization technique has been loss-of-resistance (LOR) to saline or air, which has fairly accurate results for needle placement and remains popular (2).…”

Effects of Adding Clonidine to Bupivacaine for Caudal Analgesia in children

“…The limitation of bupivacaine is the short duration of action, about four to six hours when administered as a 'single shot technique'. Several adjuvants such as opioids, ketamine, midazolam, clonidine and neostigmine have been used with bupivacaine to prolong its action [1][2][3][4][5] and thus extend the duration of post-operative analgesia provided by the 'single shot' caudal technique. Clonidine, anα2 agonist has been used extensively in neuraxial blocks [6][7][8][9] and peripheral nerve blocks to prolong the action of bupivacaine.…”