Ultrasound-Guided versus Conventional Caudal Block in Children: A Prospective Randomized Study

Abstract

Background Injection to the accurate area without any complications is the main factor for the efficiencies of caudal block. The aim of this study was to compare success and the complications of conventional and ultrasound method for caudal block in children. Materials and Methods Two-hundred sixty-six American Society of Anesthesiologists (ASA) category 1 children aged between 6 months and 6 years undergoing hypospadias, circumcision, or both surgeries were randomly allocated two groups (Group C or Group H, n = 133). About 0.25% bupivacaine with 1/200000 adrenaline (total volume: 0.5 mL/kg) was injected after the needle was inserted into the sacral canal in Group C, or right after the needle pierced the sacrococcygeal ligament under longitudinal ultrasound view in Group H. Success rate of block, block performing time, number of needle puncture, success at first puncture, complication rate, age and weight of the patients encountering these complications were recorded. Results The success rate of block was similar between two groups (94.7% in Group C vs 96.2% in Group U, p > 0.05). Success at first puncture was higher in Group U than in Group C (90.2 vs 66.2%, respectively; p < 0.001). Number of needle puncture, blood aspiration, subcutaneous bulging, and bone contact was higher in Group C but none in Group U (p < 0.001) and these complications were occurred in children weighing < 16 kg and less younger than 6 years old. Conclusion We observed that the complications were not encountered, number of needle puncture was lesser, and the success rate of first puncture was higher under ultrasound with longitudinal view.

Confirmation of success rate of landmark‐based caudal blockade in children using ultrasound: A prospective analysis

“…In that study, differences were shown in first‐pass success rates and number of total puncture attempts. The nonultrasound ultrasound and ultrasound groups had a first puncture success rate of 66.2% vs 92.5%, respectively, compared to our first‐pass success rate of 46% when heterogenous proceduralists 18 …”

“…Echogenic needles were easier to see than nonechogenic needles. We did not have a comparative group of patients who received just real‐time caudal ultrasound‐guidance from the start but Karaca compared real‐time ultrasound‐imaging vs landmark technique (no ultrasound verification) and showed no statistical difference in procedure time when all blocks were performed by the same experienced physician 18 . In that study, differences were shown in first‐pass success rates and number of total puncture attempts.…”

“…Dural puncture, systemic LA toxicity, and blood aspiration occurred in 0/30 patients in our small study which was not powered to detect complications. In the Karaca study, blood aspiration and bone contact occurred exclusively in the nonultrasound group at rates of 10.5% and 24.1%, respectively 18 . With infants at a higher risk of LAST, it follows that maneuvers decreasing venous or marrow cannulation should decrease the incidence of LAST 1…”

A randomized double-blinded controlled trial comparing ultrasound-guided versus conventional injection for caudal block in children undergoing infra-umbilical surgeries

“…Karaca et al . [ 10 ] in a similar study showed the first puncture success rate of 90.2% with ultrasound guidance and 66.2% with conventional block. In this study single puncture success was 64.2% in the conventional group compared to the ultrasound group 90.56%.…”

“…and Karaca et al . [ 9 10 ] showed that there was an only marginal difference in the block performing time between both groups and the difference was not statistically significant. One more difference was in the actual time taken to perform the block is different in the above studies.…”