Publications

ABSTRACT
Introduction: Caudal epidural block is a popular regional
anesthetic technique in children undergoing infraumbilical
surgeries. Conventionally, a landmark-guided method is used to
perform caudal epidural blocks. Although widely practiced, this
method is associated with procedural difficulties such as multiple
attempts, decreased success rates at the first puncture, as well
as higher rates of complications including dural puncture, rectal
injury, and intraosseous/intravenous (i.v.)/subcutaneous injections.
In order to overcome the shortcomings of the conventional
technique, various other methods have been described in clinical
practice, including imaging-assisted techniques with fluoroscopy
and Ultrasound (US).
Aim: To compare the overall block success rates between the
conventional and US-guided methods of caudal blocks in children.
Materials and Methods: The present randomised clinical study
was conducted in the Department of Anesthesiology, St. John's
Medical College, Bengaluru, Karnataka, India, from November
2019 to September 2021. Sixty-four children, aged 1-8 years,
belonging to the American Society of Anesthesiologists (ASA)
physical status grade I and II, and undergoing elective inguinal
hernial surgery were included in the study. After induction of
general anesthesia, the children were administered caudal
blocks based on the assigned groups: group A (conventional)
- patients were given 0.5 mL/kg of 0.25% bupivacaine after the
needle entered the sacral canal, and group B (USG) - patients
were given 0.5 mL/kg of 0.25% bupivacaine immediately after
the needle was visualised piercing the sacrococcygeal ligament
in the longitudinal view. The parameters studied were overall
block success rates, block performance times, and the number
of attempts taken. Descriptive statistics were reported using
mean±Standard Deviation (SD) for continuous variables and
number or percentage for categorical variables. Independent
t-test and Mann-Whitney U test were used for normally
distributed and non-normally distributed variables, respectively.
Chi-square test was used to analyse differences between
categorical variables.
Results: A total of 64 children of both genders, aged 1-8 years,
belonging to ASA physical status I and II, were included in the
study. Overall block success rates were comparable between
the two groups, with 28 (87.5%) in group A and 30 (93.8%) in
group B. The mean block performance time was longer in group
B (2.781±1.2439 minutes) compared to group A (1.578±0.5835
minutes) (p-value<0.001). The number of attempts was lower in
group B, with 100% success in the first attempt, as opposed to
68.8% in group A (p-value<0.05).
Conclusion: Ultrasound-guided caudal block does not improve
overall block success rates or block performance time, but it
does improve success rates at the first attempt and thereby
reduces the number of attempts.