Comparative study of conventional landmark versus ultrasound guided caudal block in pediatric population

Abstract

Introduction: Caudal block is the most commonly used regional anesthesia technique in pediatric population. This study aims to compare the success rate of ultrasound guided caudal block with landmark technique in children.

Methodology: One hundred and twenty-four children aged 2 to 10 years, American Society of Anesthesiologist physical status I and II undergoing elective surgery under general anesthesia with caudal epidural were enrolled. Patients were assigned into two groups, conventional landmark (Group C, n = 62) and ultrasound guided (Group U, n = 62). Demographic data, overall success rate, success at first puncture, time and number of needle punctures for successful block, and, complications were compared.

Results: Overall success rate was 94.7% with ultrasound and 91.2% with landmark technique. Success rate at first puncture was 80.7% in ultrasound group which was statistically significant when compared with the landmark group 56.1% (p= 0.005). The successful block in single puncture in ultrasound group was 82.5% and landmark technique was 61.4% (p=0.012) The mean number of punctures in landmark and ultrasound group were 1.54 ± 0.803 and 1.18 ± 0.38 (p=0.04) respectively. The mean time for successful block in Group C was 108.67 ± 30 sec and 112.69 ± 34.63 sec in Group U (p=0.15). Vascular puncture was seen in 13(22.8%)in Group C and 4(7%) in Group U. Subcutaneous bulge was comparable between two groups (p= 0.69). No intrathecal puncture was noted.

Conclusion: The use of ultrasound in caudal block increased the success rate at first attempt in pediatric population though the overall success rate, number of needle puncture, time for successful block, complications were comparable in both groups.