Feasibility and pharmacokinetics of caudal blockade in children and adolescents with 30–50 kg of body weight

Keplinger, M.; Marhofer, Peter; Klug, Wolfgang; Reiter, Birgit; Stimpfl, Thomas; Kettner, Stephan C.; Korf, Lena; Zeitlinger, Markus; Marhofer, Daniela; Triffterer, L.

doi:10.1111/pan.12972

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…Other than that, and pharmacologically speaking, caudal blocks are both feasible and can be safely applied in children up to 50 kg of body weight. 13…”

Section: Anatomical Considerationsmentioning

confidence: 99%

“…45 That said, evidence has recently been provided that caudal anaesthesia is safe and effective with ropivacaine used at 3.1 mg ml À1 for a volume of 1 ml kg À1 in children up to 50 kg of body weight. 13 Ropivacaine is known to cause less postoperative motor blockade than bupivacaine. 18,45 Its systemic absorption from the caudal epidural space is prolonged, but can be further extended by addition of epinephrine, 46 to be diluted at a 1:200 000 ratio.…”

Section: Bupivacaine Vs Ropivacainementioning

confidence: 99%

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Caudal epidural blocks in paediatric patients: a review and practical considerations

Wiegele

Marhofer

Lönnqvist

2019

British Journal of Anaesthesia

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139

137

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Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain. Caudal blocks are an efficient way to offer perioperative analgesia for painful sub-umbilical interventions. Performed on sedated children, they enable not only early ambulation, but also periprocedural haemodynamic stability and spontaneous breathing in patient groups at maximum risk of a difficult airway. These are important advantages over general anaesthesia, notably in preterm babies and in children with cardiopulmonary co-morbidities. Compared with other techniques of regional anaesthesia, a case for caudal blocks can still be made.

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“…Other than that, and pharmacologically speaking, caudal blocks are both feasible and can be safely applied in children up to 50 kg of body weight. 13…”

Section: Anatomical Considerationsmentioning

confidence: 99%

Section: Bupivacaine Vs Ropivacainementioning

confidence: 99%

Caudal epidural blocks in paediatric patients: a review and practical considerations

Wiegele

Marhofer

Lönnqvist

2019

British Journal of Anaesthesia

Self Cite

139

137

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“…Over the past 15 years, our study group has accumulated substantial experience with central nerve blocks under ultrasound guidance in children. 35,36 Based on this experience and the aforementioned ndings, we considered that ultrasound-guided epidural blocks with sedation might be a useful alternative to other techniques, which is con rmed by this rst consecutive series of children undergoing open ureteroneocystostomy. Once the epidural space was located by direct visualization and loss of resistance, the spread of LA could be directly monitored and was found to move in a cranial direction without changes in ventilation.…”

Section: Discussionmentioning

confidence: 83%

“…Compared to animal studies, however, we have previously found safe plasma levels-with a mean Cmax of 1.16 ± 0.49 (and up to 2.61) µg ml − 1 -in children and adolescents weighing 30-50 kg at the same concentration and volume of caudally injected ropivacaine. 36,37 Another nding suggesting a favorable safety pro le is that ropivacaine gets resorbed more slowly from the epidural space than bupivacaine in infants. 38 Lacking CNS data, we are unable to close the case of direct effects of ropivacaine on the CNS.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided epidural anesthesia and sedation foropen abdominal surgery in 20 consecutive children:a prospective case series and proof-of-concept study

Schmid¹,

Opfermann²,

Zadrazil³

et al. 2020

Preprint

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General anesthesia (GA) in children is associated with respiratory events and a potential for drug-induced neurotoxicity. Aiming to reduce airway manipulation and the use of GA drugs, we designed a study of abdominal surgery under epidural anesthesia in sedated, spontaneously breathing children. We enrolled 20 children (3 − 83 months, 6.3 − 25.0 kg) scheduled for open abdominal surgery with Pfannenstiel incision. Sedation was followed by ultrasound-guided epidural anesthesia. Increases in heart rate by > 15% and or patient movements upon skin incision were rated as block deficiencies. Intubation equipment for advanced airway management was kept on standby. The primary study endpoint was successful blockade, meaning that no sequential airway management was required during surgery. Secondary endpoints included any use of fentanyl/propofol intraoperatively and of postoperative analgesics in the recovery room. All 20 blocks were successful, with no block deficiencies upon skin incision, no need for sequential airway management, and stable SpO2 levels (97–100%). Surgery took a median of 120.5 minutes (IQR: 89.3–136.5) and included one bolus of fentanyl 120 minutes into a protracted operation. No more systemic analgesia had to be provided in the recovery room. Sedation and epidural anesthesia emerged as a useful alternative to GA from our consecutive case series.

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“…Barring a few exceptions, most current bioanalytical assays seek protocols that are applicable to relatively small sample volumes (e.g. 100 µL) 3 . For instance, methods that enable high-throughput analysis, while only requiring one hundred microliters of biofluid or less, would be highly desirable in a hospital environment where many samples are generated, fast determination and diagnosis are imperative, and only small samples can be taken from certain patients, such as newborns.…”

Section: Introductionmentioning

confidence: 99%

High-throughput analysis using non-depletive SPME: challenges and applications to the determination of free and total concentrations in small sample volumes

Boyacı

Bojko

Reyes‐Garcés

et al. 2018

Sci Rep

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In vitro high-throughput non-depletive quantitation of chemicals in biofluids is of growing interest in many areas. Some of the challenges facing researchers include the limited volume of biofluids, rapid and high-throughput sampling requirements, and the lack of reliable methods. Coupled to the above, growing interest in the monitoring of kinetics and dynamics of miniaturized biosystems has spurred the demand for development of novel and revolutionary methodologies for analysis of biofluids. The applicability of solid-phase microextraction (SPME) is investigated as a potential technology to fulfill the aforementioned requirements. As analytes with sufficient diversity in their physicochemical features, nicotine, N,N-Diethyl-meta-toluamide, and diclofenac were selected as test compounds for the study. The objective was to develop methodologies that would allow repeated non-depletive sampling from 96-well plates, using 100 µL of sample. Initially, thin film-SPME was investigated. Results revealed substantial depletion and consequent disruption in the system. Therefore, new ultra-thin coated fibers were developed. The applicability of this device to the described sampling scenario was tested by determining the protein binding of the analytes. Results showed good agreement with rapid equilibrium dialysis. The presented method allows high-throughput analysis using small volumes, enabling fast reliable free and total concentration determinations without disruption of system equilibrium.

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Feasibility and pharmacokinetics of caudal blockade in children and adolescents with 30–50 kg of body weight

Abstract: Based on our pharmacodynamic and pharmacokinetic results, we suggest that the body weight of 50 kg it is feasible to perform effective and safe caudal blockade in children up to 50 kg body weight.

Cited by 15 publications

References 21 publications

Caudal epidural blocks in paediatric patients: a review and practical considerations

Caudal epidural blocks in paediatric patients: a review and practical considerations

Ultrasound-guided epidural anesthesia and sedation foropen abdominal surgery in 20 consecutive children:a prospective case series and proof-of-concept study

High-throughput analysis using non-depletive SPME: challenges and applications to the determination of free and total concentrations in small sample volumes

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