Variation Between and Within Hospitals in Single Injection Caudal Local Anesthetic Dose: A Report From the Pediatric...

Area of Science:

• Anesthesiology
• Pediatric Regional Anesthesia
• Pharmacology

Background:

• Variation in healthcare practices is common, but data on anesthesia practice variation is limited.
• The Pediatric Regional Anesthesia Network (PRAN) database offers an opportunity to study practice patterns in pediatric anesthesia.
• Understanding variation in local anesthetic dosing is crucial for patient safety and effective pain management.

Purpose of the Study:

• To quantify variation in single injection caudal block dosing in infants.
• To explore potential causes of dosing variation, such as institutional practices and practitioner experience.
• To assess the relationship between the number of blocks performed and dosing variation.

Main Methods:

• Analysis of single injection caudal blocks in children under one year of age from the PRAN database.
• Evaluation of local anesthetic dose, volume, and variation across and within participating institutions.
• Statistical analysis to identify factors associated with dosing variation, including site, patient demographics, and anesthetic used.

Main Results:

• Wide variation in mean bupivacaine equivalent dose per kilogram (BE·kg) was observed across sites (1.39–2.22 BE·kg).
• Interdecile range (IDR) for doses indicated substantial variation within the mid 80% of administrations (0.21–1.48).
• Dosing variation was strongly associated with study site (Cohen's F=0.65) and local anesthetic used, but not the number of blocks performed.

Conclusions:

• Significant variability exists in caudal local anesthetic dosing and volume administered in pediatric patients.
• This variation is primarily driven by institutional differences and individual practitioner practices, not case volume.
• The current inconsistent approach to caudal block dosing lacks strong evidence and suggests a need for standardized protocols.