Ultrasound guided pediatric caudal dose: a two-center randomized controlled trial.

Area of Science:

• Pediatric Anesthesiology
• Regional Anesthesia
• Ultrasound Guidance

Background:

• The optimal drug volume for caudal anesthesia in pediatric patients remains an unresolved clinical question.
• Accurate dosing is essential for effective anesthesia and patient safety.

Purpose of the Study:

• To ascertain the minimum effective local anesthetic volume for pediatric caudal blocks using ultrasound guidance.
• To compare ultrasound-determined volumes with the established Armitage formula.

Main Methods:

• A prospective study involving 100 pediatric patients (1-3 years) undergoing infraumbilical surgery.
• Patients were randomized into two groups: ultrasound-guided volume and Armitage formula volume.
• Ultrasound was used to assess the drug volume required to reach the T10 dermatome.

Main Results:

• The mean drug volume required to reach the T10 level under ultrasound guidance was 0.755 ml/kg (P < 0.001).
• The highest sensory level achieved was T8 in the ultrasound group and T7 in the Armitage group.
• Post-procedure outcomes including FLACC scores and parental satisfaction were comparable between groups.

Conclusions:

• A caudal volume of 0.7 ml/kg of local anesthetic is sufficient to achieve the T10 sensory level in pediatric patients for infraumbilical surgeries.
• Ultrasound guidance provides an accurate method for determining effective caudal anesthetic volumes.