Ultrasound guided technique versus landmark technique for caudal epidural block in children: A randomized controlled study

Abstract

The aim of this study was to compare the two modalities of performing caudal block – ultrasonography guidance and conventional landmark technique in terms of time taken to perform the block, number of attempts to perform the block, block success at first puncture, haemodynamic changes and complications.: The study was conducted in Department of Anaesthesiology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur. It was a prospective randomized single blinded study.: This study was conducted in 62 grade ASA I and II patients of both sexes between age group of 2 - 8 years posted for elective surgeries below the level of umbilicus. Patients were randomized into 2 groups: Group C (Conventional technique) (n = 31) and group U (Ultrasound technique) (n=31) Caudal solution was prepared as Inj 0.2% Ropivacaine with Inj Fentanyl 2 mcg/kg with dosage according to Armitage formula, and was administered to both groups. The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. The analysis was 2 tailed and significance level was set at 0.05.: The mean block performance in group C was 39.3 ± 10.9 seconds while that of the Group U was 52.2 ± 11.4 seconds (P = 0.001). The time taken for identification of the caudal epidural space in Group C was 15.74 + 8.05 seconds while that of the Group U was 24.26 + 8.89 seconds (p = 0.0002). There was no significant difference noted in the number of attempts taken for the block in between both the groups. C group had a success rate of 61.29% in the first attempt while U group has a success rate of 90.32%. (p = 0.008). C group had a success rate of 83.87% while U group has a success rate of 100%. (p = 0.008). The only complication seen in the study was subcutaneous bulging which was seen significantly more in patients of C group compared to U group. Subcutaneous bulging was seen in 8 patients of C group and in 2 patients of U group. Despite the limitations in central neuraxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.