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Thoracic epidural anesthesia via the caudal approach in children
1Department of Anesthesiology, Washington University School of Medicine, St. Louis Children's Hospital, Missouri 63178.
Insights
Thoracic epidural anesthesia via the caudal approach is feasible in children up to 10 years old. This technique provides satisfactory anesthesia and pain relief, with simple checks predicting successful catheter placement.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia Techniques
- Pain Management in Children
Background:
- Thoracic epidural anesthesia is effective for thoracic and abdominal surgery pain relief.
- The caudal approach is commonly used for pediatric epidural anesthesia.
- Feasibility of thoracic epidural anesthesia via caudal approach in children requires investigation.
Purpose of the Study:
- To investigate the feasibility of thoracic epidural anesthesia using the caudal approach in pediatric patients.
- To evaluate the accuracy of catheter placement and the effectiveness of anesthesia and analgesia.
Main Methods:
- Twenty children underwent thoracic epidural anesthesia via caudal approach using a 24-G epidural catheter.
- Catheter insertion was guided by external landmarks, with stylet and a 20-G intravenous catheter.
- Radiographs confirmed catheter tip position; intraoperative and postoperative outcomes were assessed.
Main Results:
- Catheter tip position was within two vertebrae of the target in 17 of 20 subjects.
- One subject had limited catheter advancement, and two required repositioning; all were successfully placed.
- Intraoperative anesthesia and postoperative pain relief were satisfactory in all 20 children.
Conclusions:
- The caudal approach is a feasible method for thoracic epidural anesthesia in children up to 10 years old.
- Ease of stylet removal, injection, and negative aspiration/test doses predict successful placement.
- Routine radiographic confirmation may be unnecessary, simplifying the procedure.
Abstract:
We investigated the feasibility of performing thoracic epidural anesthesia via the caudal approach in 20 children (age 62 +/- 38 months and weight 18.5 +/- 7.3 kg; mean +/- standard deviation). Based on external landmarks, a predetermined length of 24-G epidural catheter (Concord Portex 20/24 microcatheter system) with stylet was passed into the epidural space through a 20-G intravenous catheter inserted through the sacrococcygeal ligament, and a radiograph of the abdomen and chest was obtained. The radiographically determined catheter tip position was within two vertebrae of the target position in 17 of 20 subjects. In one subject, it was impossible to advance the catheter more than 10 cm. The other two malpositioned catheters were successfully reinserted. Intraoperative caudal anesthesia and postoperative pain relief were satisfactory in all 20 subjects. We have found it possible to use the caudal approach to thoracic epidural anesthesia in children as old as 10 yr. Ease of removal of the stylet, ease of injection, and negative aspiration and test doses predict successful placement and obviate the need for routine radiographic confirmation of catheter position.