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Caudal Epidural Block in Pediatric Anesthesia

Overview and Anatomy

Caudal Epidural Block: An Updated Review of Anatomy and Techniques

Volumes of the spinal canal and caudal space in children zero to three years of age assessed by magnetic resonance imaging: implications for volume dosage of caudal blockade

The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging

The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults

Measuring the depth of the caudal epidural space to prevent dural sac puncture during caudal block in children

Test Your Knowledge: newborn spinal cord

Techniques and Guidance

Caudal anesthesia in pediatrics: an update

Real-Time Ultrasound Improves Accuracy of Caudal Block in Children

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

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

Ultrasound-guided caudal blockade and sedation for paediatric surgery: a retrospective cohort study

Real-Time Ultrasonography for the Placement of Caudal Epidurals for Thoracic Surgery in Infants: A Description of the Technique and Case Series

Tunnelling of caudal epidural catheters in infants

Dosing, Volume, and Drug Comparisons

Reconsidering injection volume for caudal epidural block in young pediatric patients: a dynamic flow tracking experimental study

A comparison of high volume/low concentration and low volume/high concentration ropivacaine in caudal analgesia for pediatric orchiopexy

Comparison of ropivacaine 0.1% and 0.2% with bupivacaine 0.2% for single-shot caudal anaesthesia in children

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

The minimum local anesthetic concentration of ropivacaine for caudal analgesia in children

Adjuncts and Additives

The use of additives to local anaesthetic solutions for caudal epidural blockade

Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children

The Use of Epinephrine in Caudal Anesthesia Increases Stroke Volume and Cardiac Output in Children

Monitoring and Physiologic Effects

The effects of caudal local anesthesia blockade on the Bispectral Index during general anesthesia in children

Detection of intravascular injection of regional anaesthetics in children

Outcomes and Safety

Are caudal blocks for pain control safe in children? an analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database

Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia

A Systematic Review of Caudal Anesthesia and Postoperative Outcomes in Pediatric Cardiac Surgery Patients

Special Populations and Conditions

Caudal anesthesia in children with shunt devices

Caudal block and ventricular shunt devices: beware of the consequences of increasing epidural pressure!

Tethered Spinal Cord Syndrome Discovered during Ultrasound-guided Caudal Block

Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies

Ultrasound determination of the dural sac to sacrococcygeal membrane distance in premature neonates

Hypospadias and Urologic Surgery

Caudal analgesia, hypospadias, and urethrocutaneous fistula: Does association mean causality?

Caudal Blocks and Hypospadias Repair Complications-Much Ado about Nothing or the Real Deal?

Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair

Search: caudal & hypospadias

Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery

Complications and Case Reports

Case report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies

Summary

(Optional section for synthesis, conclusions, or optinon references)

What should an anesthesiologist tell a parent of a child getting a caudal block?

An anesthesiologist should inform a parent of a child receiving a caudal block about the procedure, potential risks, benefits, and what to expect. They might say:

1. Explanation of the procedure: Describe that a caudal block is a type of regional anesthesia that involves injecting medication near the lower end of the spine to numb the lower half of the body.
2. Purpose: Explain the purpose of the caudal block, which is often to provide pain relief during and after a surgical procedure in the lower part of the body.
3. Benefits: Discuss the potential benefits, such as reduced pain and discomfort during and after the surgery.
4. Risks: Mention possible risks, including infection, bleeding, nerve damage, and allergic reactions to the medication.
5. Anesthesia process: Describe how the child will receive the anesthesia and what monitoring will be in place to ensure their safety.
6. Pre-operative instructions: Provide any necessary pre-operative instructions, such as fasting guidelines, and answer any questions the parent may have.
7. Recovery: Explain the expected recovery process, including the duration of pain relief and any potential side effects or limitations.
8. Address concerns: Be receptive to any concerns or questions the parent may have, and provide reassurance as needed.
9. Consent: Ensure that the parent understands the procedure and its risks and benefits and obtain their informed consent.
10. Follow-up: Discuss the importance of post-operative follow-up and what to do if they have questions or concerns after the procedure.

It's essential for the anesthesiologist to maintain open communication, address parental concerns, and provide information in a clear and compassionate manner.

@@ Line 1: / Line 1: @@
 {{Stub Notice}}
+= Caudal Epidural Block in Pediatric Anesthesia =
+== Overview and Anatomy ==
 [https://pubmed.ncbi.nlm.nih.gov/28337460/ Caudal Epidural Block: An Updated Review of Anatomy and Techniques]
-[https://pubmed.ncbi.nlm.nih.gov/29479931/ Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children]
+[https://pubmed.ncbi.nlm.nih.gov/29028948/ Volumes of the spinal canal and caudal space in children zero to three years of age assessed by magnetic resonance imaging: implications for volume dosage of caudal blockade]
+[https://pubmed.ncbi.nlm.nih.gov/19922508/ The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging]
+[https://pubmed.ncbi.nlm.nih.gov/23515954/ The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults]
+[https://pubmed.ncbi.nlm.nih.gov/28332251/ Measuring the depth of the caudal epidural space to prevent dural sac puncture during caudal block in children]
+[[TYK5 |Test Your Knowledge]]: newborn spinal cord
+== Techniques and Guidance ==
 [https://pubmed.ncbi.nlm.nih.gov/16682915/ Caudal anesthesia in pediatrics: an update]
-[https://pubmed.ncbi.nlm.nih.gov/30264660/ A Systematic Review of Caudal Anesthesia and Postoperative Outcomes in Pediatric Cardiac Surgery Patients]
+[https://pubmed.ncbi.nlm.nih.gov/30829666/  Real-Time Ultrasound Improves Accuracy of Caudal Block in Children]
+[https://pubmed.ncbi.nlm.nih.gov/34752689/  Comparative evaluation of landmark technique and ultrasound-guided caudal epidural injection in pediatric population: A systematic review and meta-analysis]
+[https://pubmed.ncbi.nlm.nih.gov/32267040/  Confirmation of success rate of landmark-based caudal blockade in children using ultrasound: A prospective analysis]
+[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15738 Ultrasound-guided caudal blockade and sedation for paediatric surgery: a retrospective cohort study]
+[https://journals.lww.com/aacr/fulltext/2024/10000/real_time_ultrasonography_for_the_placement_of.7.aspx Real-Time Ultrasonography for the Placement of Caudal Epidurals for Thoracic Surgery in Infants: A Description of the Technique and Case Series]
+[https://onlinelibrary.wiley.com/doi/full/10.1046/j.1460-9592.2000.00442.x?saml_referrer Tunnelling of caudal epidural catheters in infants]
-[https://pubmed.ncbi.nlm.nih.gov/27755489/ The Use of Epinephrine in Caudal Anesthesia Increases Stroke Volume and Cardiac Output in Children]
+[[File:Caudal-Kulkarni.jpeg|467x467px]]
-[https://pubmed.ncbi.nlm.nih.gov/16884465/ The effects of caudal local anesthesia blockade on the Bispectral Index during general anesthesia in children]
+== Dosing, Volume, and Drug Comparisons ==
+[https://pubmed.ncbi.nlm.nih.gov/37429622/  Reconsidering injection volume for caudal epidural block in young pediatric patients: a dynamic flow tracking experimental study]
-[https://pubmed.ncbi.nlm.nih.gov/17040315/ Caudal anesthesia in children with shunt devices]
+[https://pubmed.ncbi.nlm.nih.gov/19762734/ A comparison of high volume/low concentration and low volume/high concentration ropivacaine in caudal analgesia for pediatric orchiopexy]
 [https://onlinelibrary.wiley.com/doi/full/10.1046/j.1460-9592.2000.00532.x Comparison of ropivacaine 0.1% and 0.2% with bupivacaine 0.2% for single-shot caudal anaesthesia in children]
+[https://journals.lww.com/sjan/fulltext/2017/11040/ultrasound_assessment_of_cranial_spread_during.13.aspx Ultrasound assessment of cranial spread during caudal blockade in children: Effect of different volumes of local anesthetic]
+[https://pubmed.ncbi.nlm.nih.gov/12032008/ The minimum local anesthetic concentration of ropivacaine for caudal analgesia in children]
+== Adjuncts and Additives ==
 [https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1460-9592.1996.d01-3.x The use of additives to local anaesthetic solutions for caudal epidural blockade]
-[https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15738 Ultrasound-guided caudal blockade and sedation for paediatric surgery: a retrospective cohort study]
+[https://pubmed.ncbi.nlm.nih.gov/29479931/ Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children]
-[https://pubmed.ncbi.nlm.nih.gov/25393589/ Are caudal blocks for pain control safe in children? an analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database]
+[https://pubmed.ncbi.nlm.nih.gov/27755489/ The Use of Epinephrine in Caudal Anesthesia Increases Stroke Volume and Cardiac Output in Children]
-[https://pubmed.ncbi.nlm.nih.gov/19762734/ A comparison of high volume/low concentration and low volume/high concentration ropivacaine in caudal analgesia for pediatric orchiopexy]
+== Monitoring and Physiologic Effects ==
+[https://pubmed.ncbi.nlm.nih.gov/16884465/ The effects of caudal local anesthesia blockade on the Bispectral Index during general anesthesia in children]
 [https://pubmed.ncbi.nlm.nih.gov/9187777/  Detection of intravascular injection of regional anaesthetics in children]
-[https://pubmed.ncbi.nlm.nih.gov/23144440/ Case report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies]
+== Outcomes and Safety ==
+[https://pubmed.ncbi.nlm.nih.gov/25393589/ Are caudal blocks for pain control safe in children? an analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database]
-[[TYK5 |Test Your Knowledge]]: newborn spinal cord
+[https://pubmed.ncbi.nlm.nih.gov/22696610/ Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia]
-[[File:Caudal-Kulkarni.jpeg]]
+[https://pubmed.ncbi.nlm.nih.gov/30264660/ A Systematic Review of Caudal Anesthesia and Postoperative Outcomes in Pediatric Cardiac Surgery Patients]
-[https://pubmed.ncbi.nlm.nih.gov/28585401/ Caudal analgesia, hypospadias, and urethrocutaneous fistula: Does association mean causality?]
+== Special Populations and Conditions ==
+[https://pubmed.ncbi.nlm.nih.gov/17040315/ Caudal anesthesia in children with shunt devices]
-[https://pubmed.ncbi.nlm.nih.gov/33617329/ Caudal Blocks and Hypospadias Repair Complications-Much Ado about Nothing or the Real Deal?]
-[https://pubmed.ncbi.nlm.nih.gov/37002025/ Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair]
+[https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2007.02200.x Caudal block and ventricular shunt devices: beware of the consequences of increasing epidural pressure!]
-https://pubmed.ncbi.nlm.nih.gov/?term=caudal%20hypospadias
+[https://pubmed.ncbi.nlm.nih.gov/38498665/ Tethered Spinal Cord Syndrome Discovered during Ultrasound-guided Caudal Block]
-[https://pubmed.ncbi.nlm.nih.gov/29028948/ Volumes of the spinal canal and caudal space in children zero to three years of age assessed by magnetic resonance imaging: implications for volume dosage of caudal blockade]
+[https://pubmed.ncbi.nlm.nih.gov/22338610/ Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies]
-Kim HJ, Kim H, Lee S, Koh WU, Park SS, Ro Y. Reconsidering injection volume for caudal epidural block in young pediatric patients: a dynamic flow tracking experimental study. Regional anesthesia and pain medicine 2024;49(5):355-360. (In eng). DOI: 10.1136/rapm-2023-104409.
+[https://pubmed.ncbi.nlm.nih.gov/35115413/ Ultrasound determination of the dural sac to sacrococcygeal membrane distance in premature neonates]
-.           Ahmed Z, Mai C, Skinner KG, Yaster M. At the birth of pediatric anesthesia in Mexico: An interview with Dr. Estela Melman, a pioneering woman in medicine. Paediatric anaesthesia 2018;28(12):1066-1070. (In eng). DOI: 10.1111/pan.13518.
+== Hypospadias and Urologic Surgery ==
+[https://pubmed.ncbi.nlm.nih.gov/28585401/ Caudal analgesia, hypospadias, and urethrocutaneous fistula: Does association mean causality?]
-.           Hannallah RS, Broadman LM, Belman AB, Abramowitz MD, Epstein BS. Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery. Anesthesiology 1987;66(6):832-834.
+[https://pubmed.ncbi.nlm.nih.gov/33617329/ Caudal Blocks and Hypospadias Repair Complications-Much Ado about Nothing or the Real Deal?]
-.           Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesthesia and analgesia 2012;115(6):1353-64. (In eng). DOI: 10.1213/ANE.0b013e31825d9f4b.
+[https://pubmed.ncbi.nlm.nih.gov/37002025/ Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair]
-.           Adler AC, Belon CA, Guffey DM, Minard CG, Patel NV, Chandrakantan A. Real-Time Ultrasound Improves Accuracy of Caudal Block in Children. Anesthesia and analgesia 2020;130(4):1002-1007. (In eng). DOI: 10.1213/ane.0000000000004067.
+[https://pubmed.ncbi.nlm.nih.gov/?term=caudal%20hypospadias Search: caudal & hypospadias]
-.           Jain D, Hussain SY, Ayub A. Comparative evaluation of landmark technique and ultrasound-guided caudal epidural injection in pediatric population: A systematic review and meta-analysis. Paediatric anaesthesia 2022;32(1):35-42. (In eng). DOI: 10.1111/pan.14332.
+[https://pubmed.ncbi.nlm.nih.gov/2884900/ Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchiopexy pain in pediatric ambulatory surgery]
-.           Boretsky KR, Camelo C, Waisel DB, et al. Confirmation of success rate of landmark-based caudal blockade in children using ultrasound: A prospective analysis. Paediatric anaesthesia 2020;30(6):671-675. (In eng). DOI: 10.1111/pan.13865.
+== Complications and Case Reports ==
+[https://pubmed.ncbi.nlm.nih.gov/23144440/ Case report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies]
-.           Ponde V, Shah D, Nagdev T, Balasubramanian H, Boretsky K. Ultrasound determination of the dural sac to sacrococcygeal membrane distance in premature neonates. Regional anesthesia and pain medicine 2022;47(5):327-329. (In eng). DOI: 10.1136/rapm-2021-103344.
+== Summary ==
+* (Optional section for synthesis, conclusions, or optinon references)
-.           Brenner L, Marhofer P, Kettner SC, et al. Ultrasound assessment of cranial spread during caudal blockade in children: the effect of different volumes of local anaesthetics. British journal of anaesthesia 2011;107(2):229-35. (In eng). DOI: 10.1093/bja/aer128.
-.        Sinha C, Kumar A, Sharma S, et al. Ultrasound assessment of cranial spread during caudal blockade in children: Effect of different volumes of local anesthetic. Saudi journal of anaesthesia 2017;11(4):449-453. (In eng). DOI: 10.4103/sja.SJA_284_17.
-Eizaga Rebollar R, Carnota Martín AI, Borreiros Rodríguez E, Rojo Díez R. Tethered Spinal Cord Syndrome Discovered during Ultrasound-guided Caudal Block. Anesthesiology. 2024 Jun 1;140(6):1203-1204. doi: 10.1097/ALN.0000000000004899. PMID: 38498665.
+== What should an anesthesiologist tell a parent of a child getting a caudal block? ==
+An anesthesiologist should inform a parent of a child receiving a caudal block about the procedure, potential risks, benefits, and what to expect. They might say:
-[https://pubmed.ncbi.nlm.nih.gov/22338610/ Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies]
+* 1. Explanation of the procedure: Describe that a caudal block is a type of regional anesthesia that involves injecting medication near the lower end of the spine to numb the lower half of the body.
+* 2. Purpose: Explain the purpose of the caudal block, which is often to provide pain relief during and after a surgical procedure in the lower part of the body.
+* 3. Benefits: Discuss the potential benefits, such as reduced pain and discomfort during and after the surgery.
+* 4. Risks: Mention possible risks, including infection, bleeding, nerve damage, and allergic reactions to the medication.
+* 5. Anesthesia process: Describe how the child will receive the anesthesia and what monitoring will be in place to ensure their safety.
+* 6. Pre-operative instructions: Provide any necessary pre-operative instructions, such as fasting guidelines, and answer any questions the parent may have.
+* 7. Recovery: Explain the expected recovery process, including the duration of pain relief and any potential side effects or limitations.
+* 8. Address concerns: Be receptive to any concerns or questions the parent may have, and provide reassurance as needed.
+* 9. Consent: Ensure that the parent understands the procedure and its risks and benefits and obtain their informed consent.
+* 10. Follow-up: Discuss the importance of post-operative follow-up and what to do if they have questions or concerns after the procedure.
-[https://journals.lww.com/aacr/fulltext/2024/10000/real_time_ultrasonography_for_the_placement_of.7.aspx Real-Time Ultrasonography for the Placement of Caudal Epidurals for Thoracic Surgery in Infants: A Description of the Technique and Case Series]
+It's essential for the anesthesiologist to maintain open communication, address parental concerns, and provide information in a clear and compassionate manner.