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[Utility of epidural catheterization by the caudal route in pediatric anesthesia]
D Blanco1, J Llamazares, J Martínez-Mora
1Servicio de Anestesiologia, Reanimación y Terapia del Dolor, Hospital Universitario de Badalona Germans Trias i Pujol, Badalona, Barcelona.
Insights
Epidural anesthesia using a caudal catheter provides effective pain relief during and after surgery, comparable to direct caudal or lumbar epidural techniques. This method ensures good intraoperative and postoperative analgesia for pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Epidural anesthesia is a common method for managing pain in pediatric surgery.
- Different techniques exist for administering epidural anesthesia, each with potential benefits and drawbacks.
Purpose of the Study:
- To compare the analgesic efficacy of bupivacaine administered via a lumbar epidural catheter (inserted through the caudal route) with direct caudal or lumbar epidural administration.
- To evaluate intraoperative and postoperative pain control, sensory blockade levels, and complications associated with each technique.
Main Methods:
- A randomized study involving 140 pediatric patients (ASA I, <110 months) undergoing infraumbilical surgery.
- Three groups were compared: direct caudal puncture, lumbar puncture, and lumbar epidural catheter via caudal approach.
- Analgesia was assessed using hemodynamic parameters, CHEOPS scale, and sensory blockade levels. Catheter placement was confirmed with X-rays.
Main Results:
- All patients in the direct caudal group (Group 1) achieved sufficient analgesia.
- The lumbar epidural catheter via caudal approach (Group 3) showed a significantly lower sensory blockade level compared to Group 1.
- Catheter placement at L4-L5 was successful in 85.5% of Group 3 patients, with comparable complications across groups.
Conclusions:
- Epidural anesthesia via a caudal catheter provides intra- and postoperative analgesia comparable to lumbar or direct caudal puncture.
- This technique offers a viable alternative for pediatric pain management, particularly when aiming for a specific blockade level.
Objectives:
To compare analgesic effect of bupivacaine during and after surgery when delivered through a lumbar epidural catheter entering by the caudal route with either caudal or lumbar administration of anesthetic through the needle.
Patients And Methods:
One hundred forty ASA I patients under 110 months undergoing infraumbilical surgery were studied. The children were distributed randomly into 3 groups: group 1, caudal puncture and anesthesia with 2.5 mg/kg bupivacaine 1:200,000; group 2, lumbar puncture at L4-L5 and 1.25 mg/kg of the same local anesthetic; and group 3, epidural catheter in the caudal space up to L4-L5 and 1.25 mg/kg of the same local anesthetic administered through the catheter (Minipack: SYSTEM 2-Portex). The patients were anesthetized with endovenous or inhalational anesthetics. Variables recorded were analgesia during surgery (hemodynamic constants) and afterwards (CHEOPS scale), level of cutaneous sensory blockade immediately after the operation and its relationship to age, complementary analgesia used and complications. X-rays of the distal end of the catheter were taken in group 3.
Results:
Analgesia during and after surgery was sufficient for all patients in group 1. Two patients, 1 from group 2 and 1 from group 3, were eliminated due to lack of analgesia during surgery. The level of cutaneous sensory blockade attained was significantly lower in group 3 than in group 1, and only in group 1 were we able to establish a linear correlation between level of sensory blockade and age (R = 0.51; p < 0.01). In group 3, 85.5% of the catheters reached L4-L5. Complementary analgesia was similar in the three groups. Complications included 5 cases of blood loss at the point of puncture in groups 1 and 2, and 1 case of catheter penetration of the juncture in group 3.
Conclusions:
Epidural anesthesia by way of a catheter entering by the caudal space allows us to achieve intra- and postoperative analgesia of comparable quality to that afforded by a lumbar approach or a single direct caudal puncture.