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Updated: Sep 29, 2025
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Published on: January 31, 2025
Real-time ultrasound-guided epidural catheter placement in infants: a case series
Manoj Kamal1, Mritunjay Kumar2, Pooja Bihani3
1All India Institute of Medical Sciences, Anaesthesiology & Critical Care, Jodhpur, India.
Insights
Ultrasound (US)-guided epidural catheter placement in infants is safe and effective. This technique improves success rates and reduces complications for pediatric pain management.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging in Pediatrics
Background:
- Ultrasound (US) guidance for epidural catheter insertion is underutilized in pediatric practice despite reported benefits.
- Pediatric anatomy, including unfused bones and shallow epidural depth, offers unique advantages for US imaging.
Observation:
- A case series involving 10 infants successfully underwent real-time US-guided epidural catheter placement.
- Procedures were performed in lower thoracic and upper lumbar interspaces using a high-frequency US probe.
Findings:
- Real-time ultrasound guidance significantly enhances the success rate of epidural catheter placement in infants.
- The use of US guidance is associated with a reduction in procedural complications.
Implications:
- Widespread adoption of US-guided epidurals can improve pediatric pain management outcomes.
- This technique offers a safer and more effective approach to neuraxial anesthesia in neonates and infants.
Abstract:
Although epidural catheter insertion under ultrasound (US) guidance in the pediatric age group has been reported in the literature, it is yet to be adopted widely in clinical practice. The incomplete fusion of bones in pediatric patients provides an acoustic window for the US. The epidural space in children is at shallow depth, hence a high-frequency probe, which provides better resolution can be used. We present a case series in which real-time US-guided epidural catheter placement was performed in 10 infants in lower thoracic and upper lumbar interspaces. We reiterate that the use of real-time US during epidural catheter placement in patients increases the success rate of epidural catheter placement while decreasing procedural complications.
