Caudal Anesthesia in Pediatric Lower Limb Procedures

Abstract

Caudal anesthesiais one of the most popular regional blocks in children. This technique is usually performed after an inhaled or IV induction and is a usefuladjunct during general anesthesia and for providing postoperative analgesia after genital, lower abdominal, and lower limb operations. The quality and level of the caudal blockade is dependent on the dose, volume, and concentration of the injected drug. The primary local anesthetic agents usedin pediatric regional techniques are 2-chloroprocaine, lidocaine, bupivacaine, ropivacaine, mepivacaine, and tetracaine. Levobupivacaine has recently been used and may replacae the racemic mixture of bupivacaine because of its decreased potential for central nervous system toxicity and cardiotoxicity. All local anesthetics block the generation and propagation of impulses in excitable tissues. Single-shot caudal anaesthesia with local anaesthetic (bupivacaine) is the most commonly used regional technique for intraoperative and postoperative pain relief in children. The popularity of this technique is due to its simplicity and frequent success. However, the single-shot "kiddie caudal" may have only a short duration of action. Placement of a catheter into the caudalepidural space adds to the risk of infection and tends to prevent early mobilization.