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Is tissue coring a real problem after caudal injection in children
Sibel Baris1, Fuat Guldogus, Yakup Sancar Baris
1Department of Anaesthesiology, Ondokuz Mayis University, Samsun, Turkey. sbaris@omu.edu.tr
Insights
Tissue coring during pediatric caudal blocks is uncommon with both hollow and specialized caudal needles. This study found no significant difference in cell transport between the two needle types, suggesting low risk for this procedure.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Techniques
Background:
- Caudal injections are common in pediatric pain management.
- Concerns exist regarding potential tissue coring with needles during these procedures.
- Evaluating needle types for safety and efficacy is crucial.
Purpose of the Study:
- To investigate tissue coring during caudal injections in children using 22-gauge (G) hollow needles versus 22-G caudal block needles.
- To analyze the cellular composition of any potential coring material.
Main Methods:
- Seventy children undergoing caudal block anesthesia were randomized into two groups.
- Group I received a 22-G hollow needle; Group II received a 22-G caudal block needle.
- Needles were flushed, and material analyzed by a pathologist for cell types and mitotic activity.
Main Results:
- Nucleated cells without mitotic activity were found in 8.5% of both groups.
- Bloody material was present in 8.5% (Group I) and 2.8% (Group II).
- Non-nucleated epidermal cells were detected in over 94% of patients in both groups; no cells with mitotic activity were observed.
Conclusions:
- The incidence of transporting nucleated epidermal cells without mitotic activity during caudal puncture is low.
- There is no significant difference in cell transport between 22-G hollow and 22-G caudal block needles.
- While rare, the potential for transporting nucleated cells with mitotic activity from the stratum basale cannot be entirely ruled out.
Background:
The aim of this study was to determine whether tissue coring occurs with 22-G hollow needle and 22-G caudal block needle during caudal injection in children, as well as evaluating the nature of the coring material if it did occur.
Methods:
Seventy children were randomly allocated to two groups and caudal block was performed with either 22-G hollow (group I) or 22-G caudal block (group II) needle under general anesthesia. The needles and guides were washed with 0.5 ml of 70% ethanol in a sterile tube and were evaluated by a pathologist blinded to the type of needle used, for the type and number of cells.
Results:
Nucleated cells, which have no mitotic activity, were present in 8.5% in each study group and bloody material was present in 8.5 and 2.8%, in group I and II, respectively. Non-nucleated epidermal cells were detected in 94.2 and 97.1% of the patients in group I and II, respectively. However, cells with mitotic activity from the stratum basale were not detected in any slides.
Conclusions:
The incidence of transporting nucleated epidermal cells with no mitotic activity from stratum spinosum during puncture for caudal block is low and no differences exist between different types of needle used. However, it may also suggest that transporting nucleated cells with mitotic activity from the stratum basale may be possible during caudal puncture.
