The effect of volume of local anesthetic on the anatomic spread of caudal block in children aged 1-7 years

Thomas, Mark; Roebuck, Derek J.; Yule, Casey S.; Howard, Richard

doi:10.1111/j.1460-9592.2010.03422.x

Cited by 28 publications

(19 citation statements)

References 10 publications

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“…Koo has recently provided support for this line of reasoning by showing that also immediate radiographic visualization of local anesthetics mixed with radio‐opaque dye (volumes ranging 0.5–1.25 ml·kg −1 ) usually fails to reach higher than the thoraco‐lumbar junction (Th10‐L2) (12), corroborating previously published results from the same group (13). Similar observations following the injection of radio‐opaque dye have also been found by Thomas & Howard (14). Thus, both immediate ultrasound assessment and early radiographic determination using radio‐opaque dye will generate comparable results that both differ considerably from results generated by use of the predictive equations based on cutaneous testing.…”

Section: Discussionsupporting

confidence: 86%

Segmental distribution of high‐volume caudal anesthesia in neonates, infants, and toddlers as assessed by ultrasonography

Lundblad

Lönnqvist

Eksborg

et al. 2010

Pediatric Anesthesia

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Background: The aim of this prospective, age‐stratified, observational study was to determine the cranial extent of spread of a large volume (1.5 ml·kg−1, ropivacaine 0.2%), single‐shot caudal epidural injection using real‐time ultrasonography. Methods: Fifty ASA I‐III children were included in the study, stratified in three age groups; neonates, infants (1–12 months), and toddlers (1–4 years). The caudal blocks were performed during ultrasonographic observation of the spread of local anesthetic (LA) in the epidural space. Results: A significant inverse relationship was found between age, weight, and height, and the maximal cranial level reached by 1.5 ml·kg−1 of LA. In neonates, 93% of the blocks reached a cranial level of ≥Th12 vs 73% and 25% in infants and toddlers, respectively. Based on our data, a predictive equation of segmental spread was generated: Dose (ml/spinal segment) = 0.1539·(BW in kg)–0.0937. Conclusions: This study found an inverse relationship between age, weight, and height and the number of segments covered by a caudal injection of 1.5 ml·kg−1 of ropivacaine 0.2% in children 0–4 years of age. However, the cranial spread of local anesthetics within the spinal canal as assessed by immediate ultrasound visualization was found to be in poor agreement with previously published predictive equations that are based on actual cutaneous dermatomal testing.

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Section: Discussionsupporting

confidence: 86%

Segmental distribution of high‐volume caudal anesthesia in neonates, infants, and toddlers as assessed by ultrasonography

Lundblad

Lönnqvist

Eksborg

et al. 2010

Pediatric Anesthesia

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“…The effect of caudal block is influenced by the volume and concentration of local anesthetics , the methods of anesthesia , and other patient individual factors (e.g., age, weight, and height) . There is a positive, but quantitatively small correlation between injected volumes of local anesthetic and the cranial spread of caudally administered local anesthetics .…”

Section: Discussionmentioning

confidence: 99%

Caudal dexmedetomidine decreases the required concentration of levobupivacaine for caudal block in pediatric patients: a randomized trial

She

Zhang

Song

2013

Pediatric Anesthesia

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“…64 Radiography and ultrasound revealed that, no matter how much of a local anaesthetic was used, its cranial spread never seemed to reach past the T-10 level immediately upon injection. 62,64,65 In contrast, skin testing revealed T-4 dermatomal levels within several minutes of carrying out the injection. Lundblad and colleagues 7 discovered a rebound mechanism of CSF behind this phenomenon.…”

Section: Cranial Reboundmentioning

confidence: 97%

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

Wiegele

Marhofer

Lönnqvist

2019

British Journal of Anaesthesia

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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The effect of volume of local anesthetic on the anatomic spread of caudal block in children aged 1-7 years

Abstract: Incrementally increasing the volume of injectate between 0.5 and 1.0 results in a modest increase in the spread of the caudal solution. It is unlikely that volumes of <1 ml will reliably reach a vertebral level that is higher than L2.

Cited by 28 publications

References 10 publications

Segmental distribution of high‐volume caudal anesthesia in neonates, infants, and toddlers as assessed by ultrasonography

Segmental distribution of high‐volume caudal anesthesia in neonates, infants, and toddlers as assessed by ultrasonography

Caudal dexmedetomidine decreases the required concentration of levobupivacaine for caudal block in pediatric patients: a randomized trial

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

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