Epidural pressure changes following caudal blockade: a prospective, observational study.

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Neurosurgery

Background:

• Case reports suggest anesthetic agents in the epidural space may cause compartment syndrome.
• Single-shot caudal epidural anesthesia is considered safe, but epidural space pressure changes are not well-documented.

Purpose of the Study:

• To investigate pressure changes in the caudal epidural space following local anesthetic administration.
• To provide preliminary data for future study designs on caudal epidural anesthesia safety.

Main Methods:

• Prospective measurement of caudal epidural space pressure in 31 pediatric patients.
• Pressures recorded at loss of resistance, post-bolus injection, and at 15-second intervals up to 3 minutes.

Main Results:

• Initial pressure at loss of resistance was 35.6 ± 27.8 mmHg.
• Post-bolus injection pressure (1 mL/kg) reached 192.5 ± 93.3 mmHg.
• Pressure returned to baseline within 45-60 seconds, with rapid decreases after the initial peak.

Conclusions:

• Local anesthetic bolus administration causes a marked, transient increase in caudal epidural pressure.
• Sustained increases in epidural pressure are unlikely with slow epidural catheter infusions.