Spinal Versus Epidural Blockade In Children

Abstract

Regional anaesthetic techniques are now widely used in children undergoing surgery. Despite a published history of nearly a century, these techniques were restricted to small numbers of practitioners in few centres until relatively recently. The last I 0 to 15 years have seen these techniques become commonplace in all types of hospital where children undergo surgery. This is particularly true of subarachnoid and epidural blocks (Rowney and Doyle, 1998). Caual Epidural Blockade: The technique of epidural analgesia using a single injection of local anaesthetic to the epidural space via the caudal approach combines the advantages of a simple technique with a high success rate. With appropriate selection of the patient, the procedure, drug concentration and maximum dose of local anaesthetic (bupivacaine or ropivacaine) the procedure is extremely safe, does not cause troublesome urinary retention or leg weakness and may be used in outpatients. For these reasons, single-shot caudal epidural blockade is one of the commonest local anaesthetic techniques used in paediatric anaesthesia (Broadman et al., 1987) & (Gunter, 1991). Caudal epidural blockade can be used effectively in selected children to provide both intra-operative anaesthesia and postoperative analgesia for many operations below the umbilicus. These include orchidopexy, circumcision and inguinal herniotomy, lower limb and pelvic orthopaedic surgery and lower abdominal surgery in neonates and infants where low thoracic dermatomes may be blocked. It has been used as the sole technique for inguinal hernia repair in ex-premature infants at risk of postoperative apnoea (Gallacher, 1993). When performed safely by experienced anaesthetists, caudal epidural blockade in children can provide excellent intra-operative and postoperative analgesia with a very low incidence of serious complications (Gunter, 1991). Epidural analgesia: The use of epidural analgesia in children was described in 1954 as an alternative to general anaesthesia in high-risk neonates and children (Ruston, 1954). The technique did not become widely used in children because of difficulties in performing it and concerns about potential complications when it is performed in anaesthetized patients.