Utilization of ultrasound in #pediatric anesthesia has gained increasing attention for its potential role in enhancing the precision and safety of caudal epidural blocks. The #article explores the potential benefits of U/S, especially in cases where landmark palpation is challenging, such as obesity, neonates, and infants, or in the presence of congenital vertebral malformations.
Regional #anesthesia techniques play a critical role in pediatric care Caudal epidurals constitute 40% of all regional blocks in pediatric anesthesia, and traditional landmark-based techniques show a low complication rate. Caudal epidurals are commonly used to minimize exposure to peri-operative opiates in infra-umbilical surgery.
Kim et al.'s #research revealed that using the equilateral triangle method to locate the sacral hiatus was unreliable in children under the age of 6. In another comparative study of 26 infants, Mirajali et al. palpated the PSISs easily but faced challenges in locating 15% of sacral cornua and, consequently, the sacral hiatus. Therefore, pre-scanning with U/S in this age group, where landmark-based #techniques may prove difficult, seems to be essential.
Here are some major #benefits that ultrasound can provide while performing caudal blocks in neonates;
• Visualizing crucial anatomical landmarks, including the sacral hiatus and surrounding structures, can also visualize the distribution of local #anesthetic within the epidural space.
• A valuable diagnostic tool in #neonates due to incomplete ossification of posterior vertebral elements.
• Real-time needle visualization can be done using U/S to prevent misplacement and enhance success rates.
• Increases the first puncture success rates and overall success rates in pediatric caudal blocks.
• Can benefit challenging scenarios, such as obesity and when a suspicion of spinal dysraphism exists.
Further research, especially in specific patient groups, is recommended to validate these findings.
Reference:
SHOULD THE USE OF #ULTRASOUND (U/S) BE ROUTINE PRACTICE WHEN PERFORMING CAUDAL BLOCKS?
Association of Paediatric Anaesthetists of Great Britain and Ireland
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