Lumbar Epidural Anaesthesia versus Caudal Epidural Anaesthesia- Intraoperative and Postoperative Profile in Paediatric Surgical Patients

Abstract

Introduction: Caudal and lumbar epidural are established techniques of central neuraxial blocks in paediatric anaesthesia. Learning them by landmark guidance is extremely important given the fact that they have a short learning curve and all centres may not be equipped with modern equipment like fluoroscopy and ultrasound. Aim: To compare lumbar epidural anaesthesia with caudal epidural anaesthesia in terms of the ease of needle and catheter insertion, efficacy in providing intraoperative and postoperative analgesia, haemodynamics, patient satisfaction and complications. Materials and Methods: This prospective observational study was done in the Department of Anaesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India between September 2016 and June 2018. Study included 60 patients, aged 2-15 years, of American Society of Anesthesiology (ASA) grade I and II, undergoing elective infraumbilical surgeries. Patients were either administered General Anaesthesia (GA) and 0.2% ropivacaine 0.3 mL/kg through lumbar epidural catheter, or GA and 0.2% ropivacaine 1 mL/kg through caudal epidural catheter. Pain was measured postoperatively using Face, Legs, Activity, Cry, Consolability (FLACC) score and number of rescue topups in the form of tramadol 1.5 mg/kg epidurally were noted. Student’s independent-test was employed for intergroup and, paired t-test and Fisher’s-Exact test was used for intragroup analysis. Results: Out of 60 patients, the mean age±Standard devation (SD) in lumbar technique group and caudal technique group was 8.0000±3.42405 years and 6.5667±2.93238 years, respectively. The age, gender distribution, intraoperative and postoperative vitals (heart rate, mean arterial pressure and oxygen saturation), number of rescue top ups, patient satisfaction were comparable between the two groups. On statistical comparison, needle insertion was easy in 21 patients (vs 13 in lumbar epidural group) and catheter insertion was difficult in 18 (vs 8 in lumbar epidural group) in caudal epidural block compared with lumbar epidural block (p-value=0.037 and 0.010 respectively). No complications were observed in any patient of either group except one patient in group C who had catheter occlusion in the postoperative period. Conclusion: Needle insertion was easy and catheter insertion was difficult in caudal epidural block compared with lumbar epidural block in paediatrics. Both the techniques provided comparable quality of analgesia, stable haemodynamics with minimum complications.