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Correlation Between Injected Volume and Cranial Spread in Broad-Aged Pediatric Caudal Anesthesia: A Retrospective
Feng-Fang Tsai1, Ming-Han Hsieh2, Hsing-Hao Huang1
1Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
Local and Regional Anesthesia
|February 20, 2026
Summary
New pediatric caudal anesthesia dosing formulas using weight and height improve accuracy for S1-level blocks. Ultrasound guidance enhances safety in pediatric regional anesthesia, supporting individualized dosing nomograms.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Regional Anesthesia
Background:
- Caudal block is a standard regional anesthesia for pediatric lower body surgeries.
- Conventional weight-based formulas may lead to inaccurate dosing in children with varying body types.
- Ultrasound guidance offers potential for visualizing epidural spread and optimizing dosage.
Purpose of the Study:
- To develop and compare predictive dosing formulas for pediatric caudal blocks.
- To evaluate the impact of patient factors like weight, height, and BMI on anesthetic volume requirements.
- To assess the utility of ultrasound guidance in pediatric caudal anesthesia.
Main Methods:
- Retrospective analysis of anesthetic records from 25 pediatric patients undergoing ultrasound-guided caudal blocks.
- Recording of anesthetic volumes needed for specific vertebral level spread (S1, L2, L1).
- Comparison of univariate and multivariate linear regression models incorporating weight, height, age, and BMI.
Main Results:
- Univariate regression showed volume strongly correlated with weight for S1 and L2 spread.
- An optimal multivariate model for S1 spread combined weight and height (Volume = 0.1741 × weight [kg] - 0.0234 × height [cm]).
- A weight-only model was adequate for L2 spread (volume = 0.5339 × weight [kg]), with both models predicting lower volumes than the Armitage formula.
Conclusions:
- A combined weight and height formula improves prediction for S1-level pediatric caudal blocks.
- A weight-based formula is sufficient for L2-level spread.
- Ultrasound guidance enhances procedural safety and accuracy, supporting individualized dosing nomograms for pediatric caudal anesthesia.
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