Comparison of two different methods as reliable predictors of successful caudal block in children

Abstract

ABSTRACT Background To reduce the dosages of the intraoperative anaesthetic and analgesic agents, the caudal block is most frequently used in children. The work aims to investigate the efficacy of perfusion index (PI) and heart rate (HR) variations following the caudal block in determining the onset and appropriateness of the caudal block in children. Patients and methods After induction of general anaesthesia, 0.5–1 ml/kg of 0.25% bupivacaine according to the needed block level using a 22-gauge needle. Bupivacaine dose was given as an initial injection of 0.2 ml/kg for 3–4 s; the remaining dose was given at the same flow after 1 min. The lowest HRs were observed during and up to 1 min after the initial injection, as well as during and up to 1 min after the complete drug delivery. Prior to and every 2 min following the caudal block, the PI of all children was measured. Results There was a significant difference between the caudal success group and the caudal failure group regarding median PI (p < 0.001). At the initial and total caudal bupivacaine doses, there was a significant fall between the median HR caudal success group and the median HR caudal failure group (p < 0.001). Conclusion A decrease in HR of −2 and −3 beats/minute during or shortly after an initial and entire caudal drug injection, respectively, and median PI are reliable methods in the prediction of caudal success.