Caudal epidural block in children and infants: retrospective analysis of 2088 cases

Abstract

BACKGROUND AND OBJECTIVES:Regional anesthesia is usually preferred as caudal block via the epidural space. However, the number of large-scale studies including pediatric caudal blocks is small. The objective of this study was to evaluate complications and side effects of local anesthetics and adjuvant drugs.DESIGN AND SETTING:Retrospective, descriptive study of cases occurring during the period December 2007 to October 2009.METHODS:Of 4815 medical records were screened, 2088 pediatric cases were identified and included in this study.RESULTS:As a local anesthetic, we preferred mostly levobupivacaine in 1669 (79.9%) patients and bupivacaine in 419 (20.1%) patients. As adjuvant drug, we preferred mostly morphine (41 patients), fentanyl (7 patients) and adrenaline (6 patients) in 54 (2.5%) patients. For general anesthesia induction, we preferred mostly propofol (1996 patients, 94.2%); for maintenance, sevoflurane (1773 patients, 84.9%). For airway control, we preferred mostly the ProSeal laryngeal mask (PLMA), in 1008 (48.2%) patients. One thousand six hundred five (76.9%) patients were from outpatient clinics and 483 (23.1%) patients were from inpatient clinics. No permanent complication was encountered after caudal blocks.CONCLUSION:We conclude that caudal epidural blocks are a safe and effective method for subumbilical day-case pediatric surgeries when performed by anesthetists.

Assessment of Pulse Oximeter Perfusion Index in Pediatric Caudal Block under Basal Ketamine Anesthesia

“…Previous studies demonstrated that PI could provide an early and reliable indicator of the onset of epidural anesthesia and intravascular injection of epinephrine-containing epidural test dose in adults [5, 7]. However, different from epidural anesthesia or epidural testing dose in conscious adult patients, caudal blocks in pediatric patients were mostly performed under sedation or general anesthesia, such as ketamine or sevoflurane [8, 9].…”

“…In spite of this, PI is still able to detect onset of successful caudal block much earlier and more consistently than either MAP or HR. The drawback in our study was that we imposed arbitrary criteria on the endpoint being studied [5], although these endpoints were based on previous published data.…”

“…PI can provide useful information about the peripheral perfusion status of the patients. Recent study suggested that PI could be used as an early and sensitive indicator to assess the development of epidural-induced sympathectomy in conscious adults; it is more sensitive than other parameters such as changes of skin temperature gradients or mean arterial pressure (MAP) [5]. Different from adult epidural anesthesia, pediatric caudal anesthesia is usually performed under ketamine anesthesia, and ketamine itself may change the sympathetic tone [6]; thus changes of PI in these patients may be unpredictable.…”

25 years of experience, thousands of caudal blocks, and no dural puncture. What happened today?

“…Dural puncture was reported by Beyaz et al. (1) in 0.19% of patients (4/2088), aged 18 days–11 years. Unfortunately, possible causes for dural punctures were not further investigated.…”

‘Help! I need somebody’: getting timely assistance in clinical practice

“…More specific to caudal blocks, one retrospective analysis of 2088 caudal blocks [8] found the following complications; vessel puncture (1.9%), subcutaneous infiltration (1.5%) and dural puncture (0.2%). Other known complications are infection, haematoma, motor block, urinary retention and bowel perforation.…”