Thoracic epidural anesthesia via the caudal approach in children

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J B Gunter1, C Eng

  • 1Department of Anesthesiology, Washington University School of Medicine, St. Louis Children's Hospital, Missouri 63178.

Anesthesiology
|June 1, 1992
PubMed

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.

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