Caudal Anesthesia

Chinar Sanghvi, Anterpreet Dua, Chinar Sanghvi, Anterpreet Dua

Excerpt

Caudal anesthesia is a commonly used regional anesthetic technique that can be useful in providing peri- and post-operative analgesia. It can serve as the sole anesthetic or can be an adjuvant to general anesthesia. The utility of caudal anesthesia occurs mainly in pediatrics for sub-umbilical surgeries and adults for chronic low back pain management. Per a retrospective study of 750 caudal blocks performed in children conducted by Dalens et al., a success rate of 96% was reported. With the advent of fluoroscopy and ultrasound-guided caudal epidural placement, proper needle placement is assessable to reduce block failure rates further.

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References

    1. Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg. 1989 Feb;68(2):83-9.
    1. Chen CP, Tang SF, Hsu TC, Tsai WC, Liu HP, Chen MJ, Date E, Lew HL. Ultrasound guidance in caudal epidural needle placement. Anesthesiology. 2004 Jul;101(1):181-4.
    1. Kao SC, Lin CS. Caudal Epidural Block: An Updated Review of Anatomy and Techniques. Biomed Res Int. 2017;2017:9217145.
    1. Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M. Bacterial colonization and infection rate of continuous epidural catheters in children. Anesth Analg. 1998 Apr;86(4):712-6.
    1. Sethna NF, Clendenin D, Athiraman U, Solodiuk J, Rodriguez DP, Zurakowski D. Incidence of epidural catheter-associated infections after continuous epidural analgesia in children. Anesthesiology. 2010 Jul;113(1):224-32.
    1. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-517.
    1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician. 2002 Apr;5(2):133-48.
    1. Silva M, Halpern SH. Epidural analgesia for labor: Current techniques. Local Reg Anesth. 2010;3:143-53.
    1. Hilt H, Gramm HJ, Link J. Changes in intracranial pressure associated with extradural anaesthesia. Br J Anaesth. 1986 Jun;58(6):676-80.
    1. Grocott HP, Mutch WA. Epidural anesthesia and acutely increased intracranial pressure. Lumbar epidural space hydrodynamics in a porcine model. Anesthesiology. 1996 Nov;85(5):1086-91.
    1. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018 Apr;43(3):263-309.
    1. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition): Erratum. Reg Anesth Pain Med. 2018 Jul;43(5):566.
    1. Wedel DJ, Horlocker TT. Regional anesthesia in the febrile or infected patient. Reg Anesth Pain Med. 2006 Jul-Aug;31(4):324-33.
    1. Markakis DA. Regional anesthesia in pediatrics. Anesthesiol Clin North Am. 2000 Jun;18(2):355-81, vii.
    1. Shin S, Kim JY, Kim WO, Kim SH, Kil HK. Ultrasound visibility of spinal structures and local anesthetic spread in children undergoing caudal block. Ultrasound Med Biol. 2014 Nov;40(11):2630-6.
    1. Suresh S, Ecoffey C, Bosenberg A, Lonnqvist PA, de Oliveira GS, de Leon Casasola O, de Andrés J, Ivani G. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Reg Anesth Pain Med. 2018 Feb;43(2):211-216.
    1. Shukla U, Prabhakar T, Malhotra K. Postoperative analgesia in children when using clonidine or fentanyl with ropivacaine given caudally. J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):205-10.
    1. Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases. 2017 Aug 16;5(8):307-323.
    1. Datta R, Upadhyay KK. A Randomized Clinical Trial of Three Different Steroid Agents for Treatment of Low Backache through the Caudal Route. Med J Armed Forces India. 2011 Jan;67(1):25-33.
    1. Barham G, Hilton A. Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram. Eur Spine J. 2010 Sep;19(9):1479-83.
    1. Eastwood D, Williams C, Buchan I. Caudal epidurals: the whoosh test. Anaesthesia. 1998 Mar;53(3):305-7.
    1. Dave NM, Garasia M. A comparison of the effectiveness of predictors of caudal block in children-swoosh test, anal sphincter tone, and heart rate response. J Anaesthesiol Clin Pharmacol. 2012 Jan;28(1):17-20.
    1. Afshan G, Khan FA. Total spinal anaesthesia following caudal block with bupivacaine and buprenorphine. Paediatr Anaesth. 1996;6(3):239-42.
    1. Brown DL, Ransom DM, Hall JA, Leicht CH, Schroeder DR, Offord KP. Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg. 1995 Aug;81(2):321-8.

Source: PubMed

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