Comparison of Ultrasound Guided with Conventional Landmark Technique Caudal Block in Pediatric Patients Scheduled for Lower Abdomen Surgery under General Anesthesia: A Prospective Randomized Study
Abstract
Background: Perioperative pain in pediatric population is a special concern and Caudal block is easy to perform extensively safe if used in children, resulting in low pain scores and when combined with general anaesthesia, it reduces the requirement for volatile agents, opioids, improved postoperative analgesia, and earlier extubation. Ultrasound guided caudal block has reduced the complication rates such as inadvertent dural or vascular puncture. Aim of the study was to compare the success rate of ultrasound guided with conventional landmark technique caudal block in pediatric patients undergoing lower abdominal surgery under general anaesthesia.
Methods: Hundred pediatric patients, ASA class I, age between 6 months to 7 years of either sex, posted for lower abdomen surgery under general anaesthesia were randomly divided in to two groups. In group C- The group with caudal block using conventional landmark technique was used and Group U- The group with caudal block using ultrasound technique was used. Primary objectives of the study to find out the success rate of block in both the groups.
Results: The demographic data were comparable in group C and group U. Significant difference was seen in the distribution of successful block between group C and group U. (p value 0.008) block was successful in 96% of patients in group U which was significantly higher as compared to group C (76%). significant difference was seen in the distribution of number of attempts between group C and group U. (p value 0.001).
Conclusion: We conclude that Caudal block by ultrasound technique increases the first puncture success rate, decreases the number of multiple needle puncture attempts and overall success rate when compared to the conventional landmark technique in pediatric patients undergoing lower abdomen surgery.
[2] Motoyama E, Davis P. Smith's anesthesia for infants and children. Philadelphia: Mosby Elsevier; 2006.
[3] Panse N, Kulkarni S, Bhojane U, Yelgudkar R. Comparison of Two Doses of Dexmedetomidine as Adjuvant to Ropivacaine in Ultrasound Guided Adductor Canal Block: Randomised Double-Blind Controlled Trial. Arch Anesth & Crit Care. 2022;8(2):110-117
[4] Dabir S, Mosaffa F, Tanghatari H, Hosseini B. A Randomized, Double-Blind, Comparative Study of the Analgesic Efficacy of Perineural Dexmedetomidine as Adjuvant to Ropivacaine versus Ropivacaine Alone in Ultrasound Guided Saphenous Nerve Block after Anterior Cruciate Ligament Reconstruction Surgery. Arch Anesth & Crit Care. 2021;7(3):123-128.
[5] Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anaesthesia inchildren: a one-year prospective survey of the French language society of pediatricanesthesiologists. Anesth Analg 1996; 83: 904–12.
[6] Tobias JD. Postoperative analgesia and intraoperative inhalational anesthetic requirementsduring umblical herniorrhaphy in children: postinsicional local infiltration versus preinsicionalcaudal block. J Clin Anesth. 1996; 8: 634–38.
[7] Tsui BC, Tarkkila P, Gupta S, Kearney R. Confirmation of caudal needle placement using nervestimulation. Anesthesiology. 1999; 91: 374– 78.
[8] Assmann N, McCartney CJ, Tumber PS, Chan VW. Ultrasound guidance for brachial plexus localization and catheter insertion after complete forearm amputation. Reg Anesth Pain Med. 2007; 32(1):93.
[9] 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 inchildren. Paediatr Anaesth. 2013; 23(5):395-400.
[10] Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, Ekinci M, Gölboyu BE, Celik EC, et al. Ultrasound-guided versus conventional injection for caudal block inchildren: A prospective randomized clinical study. J Clin Anesth. 2018; 44:91-96
[11] Aggarwal A, Aggarwal A, Harjeet, Sahni D. Morphometry of sacral hiatus and its clinicalrelevance in caudal epidural block. Surg Radiol Anat. 2009;31(10):793–800
[12] Kao S, Lin C. Caudal Epidural Block: An Updated Review of Anatomy andTechniques. BioMed Research International. 2017; 2017:1-5
[13] Fournier-Charrière E, Tourniaire B, Carbajal R, Cimerman P, Lassauge F, Ricard C, et al. EVENDOL, a new behavioral pain scale for children ages 0 to 7 years in the emergency department: design and validation. Pain. 2012; 153:1573-82.
[14] Beltramini A, Milojevic K, Pateron D. Pain Assessment in Newborns, Infants, and Children. Pediatr Ann. 2017; 46: 387-95
[15] Chen CP, Tang SF, Hsu TC., et al. Ultrasound guidance in caudal epidural needle placement. Anesthesiology. 2004; 101 (01) 181-184.
[16] Orme RM, Berg SJ. The ‘swoosh’ test--an evaluation of a modified ‘whoosh’ test in children. Br J Anaesth. 2003; 90 (01) 62-65.
[17] Kim MS, Han KH, Kim EM, Jeong SH, Lee JR. The myth of the equiangular triangle for identification of sacral hiatus in children disproved by ultrasonography. Reg Anesth Pain Med. 2013; 38 (03): 243-247.
[18] 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 (10) 946-949.
[19] Fukazawa K, Matsuki Y, Ueno H, Hosokawa T, Hirose M. Risk factors related to accidental intravascular injection during caudal anesthesia. J Anesth. 2014; 28 (06) 940-943.
[20] Pınar HU, Karaca Ö, Doğan R, Akıllıoğlu İ. Can ondansetron be used in the treatment of subdural block?. J Clin Anesth. 2016; 33: 162-163.
[21] Singh Mahima, Bamba Charu comparison of caudal epidural block using ultrasound guidance versus the conventional technique in adult patients global Journal for Research Analysis. 2019; 8: 9-11.
[22] Karaca O, Pinar HU, Gokmen Z, Dogan R. Ultrasound-Guided versus Conventional Caudal Block in Children: A Prospective Randomized Study. Eur J Pediatr Surg. 2019; 29(6):533-538.
[23] Liu JZ, Wu XQ, Li R, Zhang YJ. [A comparison of ultrasonography versus traditional approach for caudal block in children]. Zhonghua Yi Xue Za Zhi. 2012 Apr 3;92(13):882-5.
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Issue | Vol 9 No 2 (2023): Spring | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/aacc.v9i2.12509 | |
Keywords | ||
Analgesia Ultrasound Pain Abdomen |
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