Comparison of ultrasound-guided versus conventional technique for caudal block in paediatric patients

Abstract

Caudal blocks have been recommended for surgical procedures mainly below umbilicus. Their use has increased in paediatric cases as they are easy to perform with low complication rates. There have been reports of this technique being performed as a sole anaesthetic in children who may not be a suitable candidate for general anaesthesia. This study was conducted with an aim to compare the traditionally used landmark guided technique of caudal block with ultrasound-guided technique in terms of intra-operative analgesia, haemodynamic parameters, time required to perform block and demand for rescue analgesia.This prospective randomized comparative study was carried out in 68 paediatric patients divided in two study groups (Group C and Group U) undergoing elective lower gastrointestinal and genito-urinary tract surgeries over a period of two years in a tertiary care hospital.The intra-operative haemodynamic parameters were comparable in both the groups. There was a significant increase in time taken to perform the block in Group U as compared to Group C (6.5 minutes v/s 15 minutes) (p-value <0.001). The success rate at first puncture was 52.2% in Group C and 47.8% in Group U. The majority of patients were relaxed and comfortable in the 1st hour post-operatively. The requirement of rescue analgesia in the post-operative period was comparable in both the groups. The conventional technique is easier and less time consuming as compared to the ultrasound-guided technique, which is newer and the practitioner needs expertise. The quality of analgesia provided by both the techniques is comparable. The frequency of complications associated with the block are fewer with the ultrasound-guided approach. Ultrasonography is the modality of choice specially in cases where detection of sacral anatomy and landmarks is difficult. However, further studies are needed to establish the role of ultrasonography in performing caudal block.