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Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized

Ahmet Murat Yayik1,2, Elif Oral Ahiskalioglu3,4, Erkan Cem Celik3,4

  • 1Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, 25070, Turkey. m_yayik@hotmail.com.

BMC Anesthesiology
|March 22, 2025
PubMed

Insights

Caudal blocks in children may increase intracranial pressure, indicated by optic nerve sheath diameter. This cranial spread of anesthetic does not affect hemodynamic stability during surgery.

Area of Science:

  • Pediatric Anesthesiology
  • Neurosurgery
  • Pain Management

Background:

  • Caudal epidural block is a common procedure for pediatric postoperative pain management.
  • Local anesthetics can spread cranially, potentially affecting intracranial pressure and cerebrospinal fluid dynamics.

Purpose of the Study:

  • To investigate the effect of caudal block on intracranial pressure in pediatric patients.
  • To evaluate changes in optic nerve sheath diameter (OSD) following caudal block.

Main Methods:

  • A study involving pediatric patients (1-7 years, ASA I-II) divided into a Caudal Block Group (CB) and a Control Group (C).
  • Group CB received 0.25% bupivacaine (1 ml/kg) via caudal block.
  • Optic nerve sheath diameter (OSD) was measured at T0, T1, T15, and T30 minutes post-procedure. Hemodynamic parameters (heart rate, blood pressure, SpO2, PCO2) were also recorded.

Main Results:

  • No significant differences in demographic data or intraoperative hemodynamic parameters between groups.
  • OSD measurements were not significantly different at T0 and T1.
  • OSD measurements at T15 and T30 were significantly higher in the Caudal Block Group compared to the Control Group (P < 0.01).

Conclusions:

  • Optic nerve sheath diameter measurement is a precise indicator of increased intracranial pressure in children.
  • Caudal block anesthesia in pediatric surgery leads to cranial spread of anesthetic, increasing intracranial pressure and OSD.
  • This increase in intracranial pressure does not manifest as significant intraoperative hemodynamic changes.
Abstract

Keywords:
Caudal epidural blockNon-invasive intracranial pressure monitoringOptic nerve sheath diameter

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