Caudal Epidural Anesthesia

Abstract

Caudal epidural anesthesia in pediatric patients was first described in 1933 as a replacement for general anesthesia in 83 children undergoing transurethral surgery, and since that time it has been shown to be useful in a variety of surgeries. The popularity of this block stems from its efficacy, simplicity, speed, and relative safety. The caudal approach to the epidural space can be used for the administration of local anesthetic and adjunct medications for either surgical anesthesia or postoperative analgesia. This technique is most commonly applied to surgical procedures occurring below the umbilicus and is frequently used as a single injection technique to be performed after induction of general anesthesia and before surgical incision for augmentation of general anesthesia and postoperative pain control. For longer procedures, a catheter can be placed to facilitate repeat dosing at the conclusion of surgery. Alternatively, more cephalad dermatomes can be anesthetized with an epidural catheter threaded to the desired level. The benefits of caudal epidural anesthesia extend beyond postoperative analgesia and include decreased intraoperative anesthetic requirements and a reduction in the neuroendocrine stress response to surgery.