Related Experiment Video
Updated: Jun 19, 2026
06:59
Laminectomy and Spinal Cord Window Implantation in the Mouse
Published on: October 23, 2019
Caudal analgesia and anesthesia techniques in children
Ban C H Tsui1, Charles B Berde
1Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada. btsui@ualberta.ca
Current Opinion in Anaesthesiology
|March 15, 2006
Summary
Caudal epidural blocks are key in pediatric anesthesia. Recent advances focus on longer-lasting blocks and safer catheter placement using new drugs and guidance techniques like ultrasound and nerve stimulation.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Caudal epidural blockade is a fundamental technique in pediatric regional anesthesia.
- Continuous advancements are crucial for improving safety and efficacy in pediatric patients.
Purpose of the Study:
- To provide a comprehensive review of recent developments in caudal anesthesia for infants and children.
- To highlight innovations in prolonging block duration and ensuring accurate catheter placement.
Main Methods:
- Review of current research on caudal anesthesia techniques.
- Evaluation of new local anesthetics, opioid and non-opioid adjuncts.
- Assessment of ultrasound and nerve stimulation for catheter guidance.
Main Results:
- Newer local anesthetics offer reduced toxicity.
- Non-opioid adjuncts like ketamine and clonidine can prolong analgesia, but ketamine availability is limited.
- Ultrasound and nerve stimulation improve epidural catheter accuracy, with nerve stimulation being more suitable for older children.
Conclusions:
- Ketamine or clonidine addition to caudal blocks extends duration, but requires careful consideration of ketamine preparation.
- Ultrasound and nerve stimulation are promising for accurate needle placement.
- While rare, caudal block complications necessitate individualized risk-benefit assessment.
Related Concept Videos
01:30Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
01:24General Anesthesia: Overview
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.