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Reconsidering Injection Volume For Caudal Epidural Block In Young Pediatric Patients: A Dynamic Flow Tracking Experimental Study – Spinal Injection

The article discusses the use of ultrasound imaging to improve the accuracy of caudal epidural block in pediatric patients. The study aimed to estimate the spread of injection volume using dynamic ultrasound imaging in young pediatric patients undergoing foot surgery. The results showed that different volumes of local anesthetics were required to reach different spinal levels, with specific volumes providing sufficient analgesia for localized foot, knee, and hip surgeries. The study concludes that the real-time dynamic flow tracking technique for caudal epidural block is recommended in young pediatric patients. The trial registration for the study is also provided

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best situated spine centre in London

Published article

CONCLUSIONS: Local anesthetics of 0.223, 0.591, and 0.797 mL.kg^(-1) could provide sufficient analgesia for localized foot, knee, and hip surgeries, respectively. However, since the required volume of the local anesthetics could not be calculated linearly, the real-time dynamic flow tracking technique for the caudal epidural block is recommended in young pediatric patients.

Spine Epidural Lumbar Caudal transforaminal Expert. Best Spinal Surgeon UK
Abstract Introduction: Caudal epidural block is a commonly used analgesic technique in pediatric patients. Ultrasound could be used to increase the accuracy of the block by visual confirmation of the drug-spreading. Therefore, we aimed to estimate the cephalad spread of injection volume by caudal route using dynamic ultrasound imaging in young pediatric patients. Methods: Forty,

Abstract

Introduction: Caudal epidural block is a commonly used analgesic technique in pediatric patients. Ultrasound could be used to increase the accuracy of the block by visual confirmation of the drug-spreading. Therefore, we aimed to estimate the cephalad spread of injection volume by caudal route using dynamic ultrasound imaging in young pediatric patients.

Methods: Forty patients, aged 6-24 months, undergoing foot surgery were included. After inducing general anesthesia, an angiocatheter was inserted into the sacral canal under ultrasound guidance. Thereafter, the probe was placed in the paramedian sagittal oblique position, and prepared 0.15% ropivacaine was injected, 1 mL at a time, up to 1.0 mL.kg-1. The ultrasound probe was moved cranially following the bulk flow of local anesthetics. Our primary outcome was the required volume of local anesthetics to reach each level of interlaminar space.

Results: The dynamic flow tracking was available in 39 patients, and the required volume of the injectate to reach L5-S1, L4-L5, L3-L4, L2-L3, L1-L2, T12-L1, and T11-T12 was 0.125, 0.223, 0.381, 0.591, 0.797, 0.960, and 1.050 mL.kg-1respectively. The required volume to reach the immediate upper spinal level was inconsistent across various spinal levels.

Conclusions: Local anesthetics of 0.223, 0.591, and 0.797 mL.kg-1 could provide sufficient analgesia for localized foot, knee, and hip surgeries, respectively. However, since the required volume of the local anesthetics could not be calculated linearly, the real-time dynamic flow tracking technique for the caudal epidural block is recommended in young pediatric patients.

Trial registrations: ClinicalTrials.gov (NCT04039295).

Keywords: analgesia; pain, postoperative; pediatrics; ultrasonography.

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Reconsidering injection volume for caudal epidural block in young pediatric patients: a dynamic flow tracking experimental study

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Abstract Introduction: Caudal epidural block is a commonly used analgesic technique in pediatric patients. Ultrasound could be used to increase the accuracy of the block by visual confirmation of the drug-spreading. Therefore, we aimed to estimate the cephalad spread of injection volume by caudal route using dynamic ultrasound imaging in young pediatric patients. Methods: Forty

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