A multicenter survey of pediatric caudal epidural anesthesia practices in resource-limited settings

Caudal epidural blocks are commonly used anesthesia techniques in children. This multicenter study used an interviewer-administered questionnaire in 28 hospitals to describe pediatric caudal epidural anesthesia practice in the Palestinian healthcare system. Devices used to access the epidural space, methods used to ensure the accuracy of access to the epidural space, methods used to ensure asepsis, local anesthetics, additives, and adjuncts used in pediatric caudal epidural blocks were collected. Responses were obtained from 162 anesthesiologists (response rate = 68.9%). Hollow needles were used to access the epidural space and catheters were used to administer local anesthetics, additives, and adjuncts in the epidural space. Aspiration before injection was the most frequently reported method to ensure accurate placement of needles, catheters, local anesthetics, additives, and adjuncts in the epidural space. Bupivacaine was the most commonly injected local anesthetic. During single short caudal epidural blocks, 57.4% of the anesthesiologists reported adhering to full aseptic techniques. The findings revealed significant variations in the practices of pediatric caudal epidural blocks. These variations could be associated with resource limitations, access to materials, local anesthetics, additives, and adjuncts. Developing and adopting evidence-based guidelines might promote congruence in pediatric caudal epidural anesthesia practices.