Ultrasound assessment of cranial spread during caudal blockade in children: effect of the speed of injection of local anaesthetics

Triffterer, L.; Machata, A.-M.; Latzke, D.; Willschke, Harald; Rebhandl, Winfried; Kimberger, Oliver; Marhofer, Peter

doi:10.1093/bja/aer502

Cited by 36 publications

(24 citation statements)

References 18 publications

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“…18,19 Postinjection (when the X-ray image was obtained), the caudal solution may still be creeping cranially and not yet has reached its highest level and there may be 'pharmacological spread' that is not visible to the naked eye on X-ray examination. 20 Our results also demonstrated that there were no differences in vital parameters like heart rate and blood pressure between the two groups despite the significantly higher spread level of the HVLC compared with the LVHC. The mechanism for this lack of hemodynamic sympathectomy was postulated to be the immaturity of the sympathetic nerve system.…”

Section: Discussionsupporting

confidence: 56%

Comparative study of higher volume lower concentration and lower volume higher concentration levobupivacaine in paediatric caudal block for postoperative pain relief in infraumbilical day care surgeries: Randomized observer blinded study

Masur¹,

Ganeshnavar²,

Hiremath³

et al. 2020

IJCA

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One of the commonly used regional anaesthesia technique for postoperative pain relief in paediatric surgery is caudal block. By increasing the volume of local anaesthetics, a higher initial level of blockade might extend the analgesic duration. Our aim was to compare analgesic durations between higher volume lower concentration and lower volume higher concentration levobupivacaine administered to children undergoing infraumbilical day care surgery. Materials and Methods: After obtaining ethical clearance and informed consent from guardian we performed randomized, prospective, observer-blinded study. Sample size calculated was 24 in each group. Caudal block was performed after induction and securing airway with appropriate size LMA. Children aged 6months to 5yr ASA I-II, received Levobupivacaine either 0.8 mL/kg of 0.375% (lower volume/ higher concentration [Group L], n 24) or 1.5 mL/kg of 0.1% solution (higher volume/ lower concentration [Group H], n 24) with radioopaque dye. Duration of analgesia and time for the 1 st dose of oral acetaminophen was noted. Results: Fluoroscopic examination showed the spread levels of Levobupivacaine to T12(T12-L2) in Group L and T6 (T4-T8) in Group H. The mean duration of analgesia in Group H was significant than in Group L, i.e., 639.091 ± 89.8628 min and 587.028 ± 87.7387 (P < 0.05) respectively: Time for the first dose of oral acetaminophen was found to be significantly longer with Group H patients than Group L. Conclusions: Caudal analgesia with higher volume lower concentration of levobupivacaine (0.1%) provides longer duration of analgesia than lower volume higher concentration levobupivacaine (0.375%) in children undergoing day-care infraumbilical surgery

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Section: Discussionsupporting

confidence: 56%

Comparative study of higher volume lower concentration and lower volume higher concentration levobupivacaine in paediatric caudal block for postoperative pain relief in infraumbilical day care surgeries: Randomized observer blinded study

Masur¹,

Ganeshnavar²,

Hiremath³

et al. 2020

IJCA

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“…A (prediction of epidural depth) Local anesthetic spread Brenner et al, 27 Lundblad et al, 35 Triffterer et al, 30 Tsui et al, 37 Ueda et al 39…”

Section: Ib (Prediction Of Epidural Depth)mentioning

confidence: 99%

“…27,30,35,37,39 Brenner et al 27 used ultrasound to show correlations between injectate volume (0.7, 1.0, or 1.3 mL/kg) and cranial spread during caudal blockade. There were significant positive correlations between 1.3 mL/kg and 0.7 mL/kg (P = 0.0002) as well as 1.3 mL/kg and 1.0 mL/kg (P = 0.03); however, the observed differences were small and did not allow for a reasonable prediction of a volume-cranial extension relationship.…”

Section: Neuraxial Anesthesiamentioning

confidence: 99%

Evidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia

Lam

Corry

Tsui

2016

Regional Anesthesia and Pain Medicine

114

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Studies in the current review provide stronger evidence and have addressed a number of outcomes that were previously inconsistent or lacked strength in evidence. In the current systematic review, we identified more studies in a shorter period compared with the previous review, and these studies contain higher levels of evidence compared with what we previously found. Randomized controlled trials and well-designed prospective observational studies have replaced case series. Stronger evidence from the literature suggests that ultrasound-guided peripheral blocks decrease block performance time when compared with nerve stimulation (but take longer than the landmark technique), increase block success, and increase block quality (as measured by analgesic consumption, block duration, and pain scores). Ultrasound guidance in neuraxial blocks improves needling time, predicts epidural depth, allows visualization of the catheter and local anesthetic spread, and improves block quality. Furthermore, we identified 2 large-scale prospective studies describing the incidence of adverse events and complications in pediatric regional anesthesia. The increase in evidence presented in this review reflects the efficacy and prevalent use of ultrasound imaging in pediatric regional anesthesia.

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“…studied the effect of the speed of injection of the local anesthetic in the primary spread of the drug. [10] Although their study did not yield any significant effect, we tried to keep the speed constant using an infusion pump.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of cranial spread during caudal blockade in children: Effect of different volumes of local anesthetic

et al. 2017

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Background:Ultrasound-guided caudal block injection is a simple, safe, and effective method of anesthesia/analgesia in pediatric patients. The volume of caudal drug required has always been a matter of debate.Materials and Methods:This present prospective, randomized, double-blinded study aimed to measure extent of the cranial spread of caudally administered levobupivacaine in Indian children by means of real-time ultrasonography. Ninety American Society of Anesthesiologists I/II children scheduled for urogenital surgeries were enrolled in this trial. Anesthesia and caudal analgesia were administered in a standardized manner in the patients. The patients received 0.5 ml/kg or 1 ml/kg or 1.25 ml/kg of 0.125% levobupivacaine according to the group allocated. Cranial spread of local anesthetic was noted using ultrasound.Results:There was no difference in the spread when related to age, sex, weight, or body mass index. A significant difference of ultrasound-assessed cranial spread of the local anesthetic was found between Group 1 (0.5 ml/kg) with both Group 2 (1 ml/kg) (P = 0.001) and with Group 3 (1.125 ml/kg) (P < 0.001) but there is no significant difference between Group 2 and Group 3 (P = 0.451) revealing that spinal level spread is only different between 0.5 ml/kg and 1 ml/kg of local anesthetic.Conclusion:In conclusion, the ultrasound assessment of local anesthetic spread after a caudal block showed that cranial spread of the block is dependent on the volume injected into the caudal space. Since there was no difference between 1 ml/kg and 1.25 ml/kg, to achieve a dermatomal blockade up to thoracic level, we might have to increase the dose beyond 1.25 ml/kg, keeping the toxic dose in mind.

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Ultrasound assessment of cranial spread during caudal blockade in children: effect of the speed of injection of local anaesthetics

Cited by 36 publications

References 18 publications

Comparative study of higher volume lower concentration and lower volume higher concentration levobupivacaine in paediatric caudal block for postoperative pain relief in infraumbilical day care surgeries: Randomized observer blinded study

Comparative study of higher volume lower concentration and lower volume higher concentration levobupivacaine in paediatric caudal block for postoperative pain relief in infraumbilical day care surgeries: Randomized observer blinded study

Evidence for the Use of Ultrasound Imaging in Pediatric Regional Anesthesia

Ultrasound assessment of cranial spread during caudal blockade in children: Effect of different volumes of local anesthetic

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