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http://dx.doi.org/10.4097/kja.d.18.00109

Caudal and epidural blocks in infants and small children: historical perspective and ultrasound-guided approaches  

Kil, Hae Keum (Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University Health System)
Publication Information
Korean Journal of Anesthesiology / v.71, no.6, 2018 , pp. 430-439 More about this Journal
Abstract
In infants and small children, ultrasound (US) guidance provides ample anatomical information to perform neuraxial blocks. We can measure the distance from the skin to the epidural space in the US image and can refer to it during needle insertion. We may also visualize the needle or a catheter during real-time US-guided epidural catheterization. In cases where direct needle or catheter visualization is difficult, US allows predicting successful puncture and catheterization using surrogate markers, such as dura mater displacement, epidural space widening due to drug injection, or mass movement of the drug within the caudal space. Although many experienced anesthesiologists still prefer to use conventional techniques, prospective randomized controlled trials using US guidance are providing increasing evidence of its advantages. The use of US-guided regional block will gradually become widespread in infants and children.
Keywords
Caudal; Children; Epidural; Ultrasound;
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1 Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother 2009; 9: 723-44.   DOI
2 Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM. Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis. J Pain 2017; 18: 605-14.   DOI
3 Ferland CE, Vega E, Ingelmo PM. Acute pain management in children: challenges and recent improvements. Curr Opin Anaesthesiol 2018; 31: 327-32.   DOI
4 American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012; 116: 248-73.   DOI
5 Tsui BC, Suresh. Ultrasound imaging for regional anesthesia in infants, children, and adolescents: a review of current literature and its application in the practice of neuraxial blocks. Anesthesiology 2010; 112: 719-28.   DOI
6 Lam DK, Corry GN, Tsui BC. Evidence for the use of ultrasound imaging in pediatric regional anesthesia: a systematic review. Reg Anesth Pain Med 2016; 41: 229-41.   DOI
7 Campbell MF. Caudal anesthesia in children. J Urol 1933; 30: 245-50.   DOI
8 Schulte-Steinberg O. History. In: Regional Anaesthesia in Children. Edited by Saint-Maurice C, Schulte-Steinberg O: New York, Appleton & Lange. 1990, pp 13-4.
9 Dogliotti AM. Research and clinical observations on spinal anesthesia: with special reference to the peridural technique. Anesth Analg 1933; 12: 59-65.
10 Ruston FG. Epidural anaesthesia in pediatric surgery. Anesth Analg 1957; 36: 76-82.   DOI
11 Ruston FG. Epidural anaesthesia in infants and children. Can Anaesth Soc J 1954; 1: 37-44.   DOI
12 Ruston FG. Epidural anaesthesia in paediatric surgery: present status in the Hamilton general hospital. Can Anaesth Soc J 1964; 11: 12-34.   DOI
13 Ecoffey C, Dubousset AM, Samii K. Lumbar and thoracic epidural anesthesia for urologic and upper abdominal surgery in infants and children. Anesthesiology 1986; 65: 87-90.   DOI
14 Murat I, Delleur MM, Esteve C, Egu JF, Raynaud P, Saint-Maurice C. Continuous extradural anaesthesia in children. Clinical and haemodynamic implications. Br J Anaesth 1987; 59: 1441-50.   DOI
15 Kil HK, Cho JE, Kim WO, Koo BN, Han SW, Kim JY. Prepuncture ultrasound-measured distance: an accurate reflection of epidural depth in infants and small children. Reg Anesth Pain Med 2007; 32: 102-6.
16 Bosenberg AT, Bland BA, Schulte-Steinberg O, Downing JW. Thoracic epidural anesthesia via caudal route in infants. Anesthesiology 1988; 69: 265-9.   DOI
17 Chawathe MS, Jones RM, Gildersleve CD, Harrison SK, Morris SJ, Eickmann C. Detection of epidural catheters with ultrasound in children. Paediatr Anaesth 2003; 13: 681-4.   DOI
18 Rapp HJ, Folger A, Grau T. Ultrasound-guided epidural catheter insertion in children. Anesth Analg 2005; 101: 333-9.   DOI
19 Tachibana N, Yamauchi M, Sugino S, Watanabe A, Yamakage M. Utility of longitudinal paramedian view of ultrasound imaging for middle thoracic epidural anesthesia in children. J Anesth 2012; 26: 242-5.   DOI
20 Willschke H, Bosenberg A, Marhofer P, Willschke J, Schwindt J, Weintraud M, et al. Epidural catheter placement in neonates: sonoanatomy and feasibility of ultrasonographic guidance in term and preterm neonates. Reg Anesth Pain Med 2007; 32: 34-40.
21 Suresh S, Long J, Birmingham PK, De Oliveira GS Jr. Are caudal blocks for pain control safe in children? an analysis of 18,650 caudal blocks from the Pediatric Regional Anesthesia Network (PRAN) database. Anesth Analg 2015; 120: 151-6.   DOI
22 Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg 1989; 68: 83-9.   DOI
23 Veyckemans F, Van Obbergh LJ, Gouverneur JM. Lessons from 1100 pediatric caudal blocks in a teaching hospital. Reg Anesth 1992; 17: 119-25.
24 Johnson SA, Young C, Olney JW. Isoflurane-induced neuroapoptosis in the developing brain of nonhypoglycemic mice. J Neurosurg Anesthesiol 2008; 20: 21-8.   DOI
25 Wang LZ, Hu XX, Zhang YF, Chang XY. A randomized comparison of caudal block by sacral hiatus injection under ultrasound guidance with traditional sacral canal injection in children. Paediatr Anaesth 2013; 23: 395-400.   DOI
26 Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, Ekinci M, Golboyu BE, Celik EC, et al. Ultrasound-guided versus conventional injection for caudal block in children: a prospective randomized clinical study. J Clin Anesth 2018; 44: 91-6.   DOI
27 Ponde VC, Bedekar VV, Desai AP, Puranik KA. Does ultrasound guidance add accuracy to continuous caudal-epidural catheter placements in neonates and infants? Paediatr Anaesth 2017; 27: 1010-4.   DOI
28 Brambrink AM, Evers AS, Avidan MS, Farber NB, Smith DJ, Martin LD, et al. Ketamine-induced neuroapoptosis in the fetal and neonatal rhesus macaque brain. Anesthesiology 2012; 116: 372-84.   DOI
29 Sinner B, Becke K, Engelhard K. General anaesthetics and the developing brain: an overview. Anaesthesia 2014; 69: 1009-22.   DOI
30 Davidson A. The effect of anaesthesia on the infant brain. Early Hum Dev 2016; 102: 37-40.   DOI
31 Houck CS, Vinson AE. Anaesthetic considerations for surgery in newborns. Arch Dis Child Fetal Neonatal Ed 2017; 102: F359-63.   DOI
32 FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women [Internet]. Silver Spring (MD): U.S. Food and Drug Administration; 2016 Dec 14 [cited 2018 Apr 22]. Available from https://www.fda.gov/Drugs/DrugSafety/ucm532356.htm.
33 Dalens BJ, Truchon R. Neural blockade for pediatric surgery. In: Cousins & Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine. 4th ed. Edited by Cousins MJ, Carr DB, Horlocker TT, Bridenbaugh PO: Philadelphia, Lippincott Williams & Wilkins, a Wolters Kluwer business. 2009, pp 596-611.
34 FDA Drug Safety Communication: FDA approves label changes for use of general anesthetic and sedation drugs in young children [Internet]. Silver Spring (MD): U.S. Food and Drug Administration; 2017 Apr 27 [cited 2018 Apr 22]. Available from https://www.fda.gov/Drugs/ DrugSafety/ucm554634.htm.
35 Ivani G, Suresh S, Ecoffey C, Bosenberg A, Lonnqvist PA, Krane E, et al. The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia. Reg Anesth Pain Med 2015; 40: 526-32.   DOI
36 Bogduk N. Clinical Anatomy of Lumbar Spine. 3rd ed. New York, Churchill Livingstone. 1987, pp 63-163.
37 Kim YA, Kim JY, Kil HK, Kim EM, Kim MK, Kim HS. Accuracy of the epidural catheter position during the lumbar approach in infants and children: a comparison among L2-3, L3-4, and L4-5 approaches. Korean J Anesthesiol 2010; 58: 458-63.   DOI
38 Blanco D, Llamazares J, Rincon R, Ortiz M, Vidal F. Thoracic epidural anesthesia via the lumbar approach in infants and children. Anesthesiology 1996; 84: 1312-6.   DOI
39 Tsui BC, Fredrickson M, Suresh S. Pediatric epidural & caudal analgesia & anesthesia. In: Textbook of Regional Anesthesia and Acute Pain Management. Edited by Hadzic A: New York, McGraw Hill. 2007, p 739.
40 Marhofer P, Bosenberg A, Sitzwohl C, Willschke H, Wanzel O, Kapral S. Pilot study of neuraxial imaging by ultrasound in infants and children. Paediatr Anaesth 2005; 15: 671-6.   DOI
41 Koo BN, Hong JY, Song HT, Kim JM, Kil HK. Ultrasonography reveals a high prevalence of lower spinal dysraphism in children with urogenital anomalies. Acta Anaesthesiol Scand 2012; 56: 624-8.   DOI
42 Shin S, Kim JY, Kim WO, Kim SH, Kil HK. Ultrasound visibility of spinal structures and local anesthetic spread in children undergoing caudal block. Ultrasound Med Biol 2014; 40: 2630-6.   DOI
43 Kil HK, Cho JE, Kim WO, Koo BN, Han SW, Kim JY. Prepuncture ultrasound-measured distance: an accurate reflection of epidural depth in infants and small children. Reg Anesth Pain Med 2007; 32: 102-6.
44 Kil HK, Koo BN, Kim WO. To make epidural catheterization less difficult in infants. Paediatr Anaesth 2006; 16: 1196-7.
45 Dalens B, Chrysostome Y. Intervertebral epidural anaesthesia in paediatric surgery: success rate and adverse effects in 650 consecutive procedures. Paediatr Anaesth 1991; 1: 107-17.   DOI
46 Busoni P, Sarti A. Sacral intervertebral epidural block. Anesthesiology 1987; 67: 993-5.   DOI
47 Park JH, Koo BN, Kim JY, Cho JE, Kim WO, Kil HK. Determination of the optimal angle for needle insertion during caudal block in children using ultrasound imaging. Anaesthesia 2006; 61: 946-9.   DOI
48 Saint-Maurice C, Landais A, Othmani H, Khalloufi M. The trans-sacral route. Can the technique be simplified? Cah Anesthesiol 1993; 41: 235-6.
49 Shin SK, Hong JY, Kim WO, Koo BN, Kim JE, Kil HK. Ultrasound evaluation of the sacral area and comparison of sacral interspinous and hiatal approach for caudal block in children. Anesthesiology 2009; 111: 1135-40.   DOI
50 Koo BN, Hong JY, Kim JE, Kil HK. The effect of flexion on the level of termination of the dural sac in paediatric patients. Anaesthesia 2009; 64: 1072-6.   DOI
51 Quinot JF, Coquelin G. Trans-sacral caudal anesthesia in ambulatory practice in infants. Our experience. Cah Anesthesiol 1993; 41: 347-8.
52 Kumagai M, Yamashita M. Sacral intervertebral approach for epidural anaesthesia in infants and children: application of "drip and tube" method. Anaesth Intensive Care 1995; 23: 469-71.   DOI
53 Osaka Y, Yamashita M. Intervertebral epidural anesthesia in 2,050 infants and children using the drip and tube method. Reg Anesth Pain Med 2003; 28: 103-7.   DOI
54 Armitage EN. Caudal block in children. Anaesthesia 1979; 34: 396.