Comparative evaluation of landmark technique and ultrasound‐guided caudal epidural injection in pediatric population: A systematic review and meta‐analysis

Jain, Dhruv; Hussain, Syed Fayyaz; Ayub, Arshad

doi:10.1111/pan.14332

Cited by 11 publications

(6 citation statements)

References 27 publications

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“…[ 26 ] Additionally, it has also been shown that ultrasound-guided epidural injections neither improve the success rate nor shorten the duration of the block; rather, they have a higher success rate of first puncture and a lower complication rate. [ 27 ] Dietrich et al[ 7 ] found that the mean effective dose of patients with TFLEI under the guidance of fluoroscopy is 0.24±0.22 mSv. The interventional physician's radiation measurements under the guidance of X-ray fluoroscopy are as follows: body, (0.42±0.99)x10 3 mSv; wrist, (1.44±2.69)x10 3 mSv.…”

Section: Discussionmentioning

confidence: 99%

A comparison between transforaminal lumbar epidural injection performed under picture archiving and communication systems-based magnetic resonance imaging planning and injection under immediate X-ray guidance

Yan,

Romeo Kenmegne,

et al. 2023

Jt Dis Relat Surg

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Objectives The study aimed to compare the treatment cost, operation time, clinical effect, and complications between punctures done under magnetic resonance imaging (MRI) planning based on picture archiving and communication systems (PACS) and punctures done under immediate X-ray fluoroscopy guidance in the treatment of lumbar disc herniation by transforaminal lumbar epidural injection. Patients and methods In this prospective study conducted between October 2016 and June 2021, 128 patients were randomly divided into Groups A and B by the random number table method. In Group A (n=66; 36 males, 30 females; mean age: 64.5±2.4 years, range, 50 to 72 years), puncture was performed by planning with PACS-based MRI; in Group B (n=62; 34 males, 28 females; mean age: 65.3±2.6 years; range, 48 to 73 years), puncture was performed under immediate X-ray guidance. The cost of treatment, duration of procedure, clinical outcome, and complications were compared between the two groups. Results The difference in treatment cost in Groups A and B was statistically significant (p<0.001), with 755.67±29.45 yuan and 1.158.08±43.92 yuan, respectively. The mean treatment time was statistically significant (p<0.001) between the groups, with 21.16±1.91 min in Group A and 37.26±2 min in Group B. However, there was no significant difference between Group A and Group B in terms of improvement in pain scores and Oswestry disability index (both p>0.05). There was also no significant difference between Group A and Group B in terms of complication rates (both p>0.05). Conclusion Compared to immediate X-ray guided puncture, the puncture method using PACS for MRI planning shortened the transforaminal lumbar epidural injection procedure time and reduced the treatment costs without exposing the physician or patient to additional radiation, while there was no significant difference in the short-term clinical outcome or complication rate.

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Section: Discussionmentioning

confidence: 99%

A comparison between transforaminal lumbar epidural injection performed under picture archiving and communication systems-based magnetic resonance imaging planning and injection under immediate X-ray guidance

Yan,

Romeo Kenmegne,

et al. 2023

Jt Dis Relat Surg

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“…A recent systematic review underlines this finding. So, ultrasound-guided caudal injection results in higher first puncture success and lower incidence of complications compared to landmark technique [ 15 ]. However, data of a RCT are with difficulty compareable to our data being a reflection of caudal blocks in children of different ages and routinely performed by anesthetists with various levels of training and not–as in RCT–by experts.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

et al. 2023

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Study objective To identify sex differences associated with caudal epidurals, the most commonly used technique of pediatric regional anesthesia, based on individually validated data of ultrasound-guided blocks performed between 04/2014 and 12/2020. Methods Prospectively collected and individually validated data of a cohort of children aged between 0–15 years was analyzed in a retrospective observational study. We included pediatric surgeries involving a primary plan of caudal epidural anesthesia under sedation (without airway instrumentation) and a contingency plan of general anesthesia. Sex-specific rates were analyzed for overall failure of the primary anesthesia plan, for residual pain, for block-related technical complications and for critical respiratory events. We used Fisher´s exact tests and multivariable logistic regressions were used to evaluate sex-specific associations. Results Data from 487 girls and 2060 boys ≤15 years old (ASA status 1 to 4) were analyzed. The primary-anesthesia-plan failure rate was 5.5% (95%CI 3.8%-7.8%) (N = 27/487) among girls and 4.7% (95%CI 3.9%-5.7%) (N = 97/2060) among boys (p = 0.41). Residual pain was the main cause of failure, with rates of 4.5% (95%CI 2.9–6.6%) (N = 22/487) among girls and 3.0% (95%CI 2.3–3.8%) (N = 61/2060) among boys (p = 0.089). Block-related technical complications were seen at rates of 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls vs 2.5% (95%CI 0.5–2.7%) (N = 51/2060) among boys and, hence, significantly more often among male patients (p = 0.023). Male sex was significantly associated with higher odds (adjusted OR: 3.18; 95% CI: 1.12–9; p = 0.029) for such technical complications regardless of age, ASA status, gestational week at birth or puncture attempts. Critical respiratory events occurred at a 1.7% (95%CI 1.2%-2.3%) rate (N = 35/2060) twice as high among boys as 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls (p = 0.21). Conclusions While the the primary-anesthesia-plan failure rate was equal for girls and boys, technical complications and respiratory events are more likely to occur in boys.

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“…1 Despite its many benefits, ultrasound guidance is used in only about 3% of these blocks. 2 Occult spinal dysraphism incidence in healthy children is about 0.1% but can reach up to 2% in those with simple urogenital anomalies (especially hypospadias). 3 As compared to a normal spine (fig.…”

Section: Tethered Spinal Cord Syndrome Discovered During Ultrasound-g...mentioning

confidence: 99%

Tethered Spinal Cord Syndrome Discovered during Ultrasound-guided Caudal Block

Eizaga Rebollar,

Carnota Martín,

Borreiros Rodríguez

et al. 2024

Anesthesiology

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Comparative evaluation of landmark technique and ultrasound‐guided caudal epidural injection in pediatric population: A systematic review and meta‐analysis

Cited by 11 publications

References 27 publications

A comparison between transforaminal lumbar epidural injection performed under picture archiving and communication systems-based magnetic resonance imaging planning and injection under immediate X-ray guidance

A comparison between transforaminal lumbar epidural injection performed under picture archiving and communication systems-based magnetic resonance imaging planning and injection under immediate X-ray guidance

Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation

Tethered Spinal Cord Syndrome Discovered during Ultrasound-guided Caudal Block

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