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A randomized double-blinded controlled trial comparing ultrasound-guided versus conventional injection for caudal

Navya Kollipara1, V Rajesh Kumar Kodali1, Aruna Parameswari1

  • 1Department of Anesthesiology, Critical Care and Pain Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai, Tamil Nadu, India.

Journal of Anaesthesiology, Clinical Pharmacology
|August 5, 2021
PubMed

Insights

Ultrasound-guided caudal blocks improve first-attempt success and reduce needle insertions in pediatric infra-umbilical surgery. This technique enhances safety and efficiency for children undergoing these procedures.

Area of Science:

  • Pediatric Anesthesiology
  • Regional Anesthesia
  • Ultrasound Guidance

Background:

  • Caudal epidural blocks are standard for pediatric infra-umbilical surgeries.
  • Conventional methods carry risks like multiple punctures and accidental dural/vascular entry.

Purpose of the Study:

  • To compare the efficacy and safety of ultrasound-guided versus conventional caudal epidural blocks.
  • To evaluate first puncture success rate and number of punctures in pediatric patients.

Main Methods:

  • 106 children (6 months-10 years) were randomized into ultrasound-guided (Group U) or conventional (Group C) groups.
  • Both groups received 0.125% bupivacaine via caudal block.
  • Primary outcome: first puncture success rate; Secondary outcomes: number of punctures, block time, overall success.

Main Results:

  • Group U showed a significantly higher first puncture success rate (90.6% vs. 64.2%, P=0.001).
  • Group U required fewer punctures (1.09 vs. 1.45, P=0.01) but had a longer block performing time (53.19s vs. 30.34s, P=0.0005).
  • Overall block success rates were comparable (98.1% vs. 100%).

Conclusions:

  • Ultrasound guidance significantly improves the first puncture success rate for caudal blocks in pediatric infra-umbilical surgery.
  • This technique reduces the number of needle insertions, enhancing patient safety.
  • Ultrasound-guided caudal injection is a valuable alternative to the conventional approach.
Abstract

Keywords:
1st puncture success rateblock performing timecaudal blockregional anesthesiaultrasound

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