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Epidural space "ballooning" during local anaesthetic injection in infants and children: An ultrasound observational

Masahiro Yagihara1, Aki Uemura2, Yoshiki Nakajima1

  • 1Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan.

Acta Anaesthesiologica Scandinavica
|July 14, 2021
PubMed

Insights

Infants require higher local anaesthetic (LA) doses for epidural analgesia due to epidural space "ballooning." This expansion, measured by ultrasound, decreases with age, potentially limiting LA spread in children.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia
  • Ultrasound in Medicine

Background:

  • Children require higher local anaesthetic (LA) doses for epidural analgesia than adults.
  • The underlying physiological reasons for this dose discrepancy remain unclear.
  • A prominent ventro-dorsal expansion of the epidural space in infants may limit cranio-caudal LA spread.

Purpose of the Study:

  • To investigate the hypothesis that epidural space expansion limits LA spread in infants.
  • To study the dimensions of the epidural space using real-time ultrasound before and after LA injection.
  • To correlate epidural space changes with patient age and LA administration parameters.

Main Methods:

  • Prospective observational study of 96 infants and children (0-12 years) undergoing abdominal surgery.
  • Real-time ultrasound (US) used to record posterior epidural space dimensions.
  • Ventro-dorsal dimension (VDD) changes ('ballooning') measured before and after LA infusion (0.5 ml kg⁻¹ at 0.54 ml s⁻¹).

Main Results:

  • 'Ballooning' positively correlated with patient age (R²=0.25) and infused LA volume (R²=0.32).
  • The 'magnitude of ballooning' (ballooning per ml of LA) negatively correlated with age (R²=0.27).
  • These correlations were statistically significant (p < .001).

Conclusions:

  • The 'magnitude of ballooning' of the epidural space diminishes as children grow.
  • This age-related decrease in epidural space expansion may impede cranio-caudal LA spread.
  • This phenomenon may partially explain the higher LA volumes needed for effective epidural blocks in pediatric patients.
Abstract

Keywords:
cranio-caudal drug spreadpaediatric epidural anaesthesiaultrasoundventro-dorsal drug spread

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