Comparison of pediatric caudal block with ultrasound guidance or landmark technique

Abstract

Background: Single-shot caudal block is a common regional technique for below umbilicus surgery in children to provide intraoperative and postoperative analgesia. Traditionally the landmark technique has been used to perform this block but correct needle placement may sometimes be difficult due to anatomical variations. We performed this clinical trial to find out the usefulness of the recently introduced ultrasound guidance in success of performing caudal block.

Methodology: This randomized controlled clinical trial was conducted after approval from hospital ethical committee. 240 children between 2 and 10 years of age, were divided into two equal groups. Patients in first group (Group USG) received caudal block with the help of real-time ultrasonography, while the second group (Group LM) received blocks using traditional landmark technique. The primary end point was a successful block which was defined as injection into the caudal canal without any resistance, no blood or CSF on aspiration and no subcutaneous swelling. The secondary end point was no tachycardia (more than 10% increase in heart rate from base line) on skin incision. We also recorded block performing time and number of needle punctures. Mean and standard deviation values were calculated for age, weight and time taken in procedure. Frequency and percentages were calculated for gender, tachycardia and success on first attempt. 

Results: There was no significant difference between the two groups in regards to age, gender or weight. However, the success on 1st attempt was higher in ultrasound group (95%) as compared to landmark technique (p = 0.000). Similarly, frequency of tachycardia on skin incision was significantly lower in ultrasound group (10%) as compared to landmark technique (p = 0.000). But the time taken was significantly higher in ultrasound group (110.88 ± 16.11 sec) as compared to landmark technique (63.62 ± 13.10 sec) {p= 0.000}

Conclusion: Success rate in placement of caudal block significantly is increased by  using ultrasound guidance as compared to standard anatomical landmarks technique, but the time taken is significantly higher in ultrasound group as compared to landmark technique.

Citation: Riaz A, Shah ARA, Jafri SAU. Comparison of pediatric caudal block with ultrasound guidance or landmark technique. Anaesth. Pain & intensive care 2019;23(1):18-22