Caudal Epidural Catheter Research Articles

Real-Time Ultrasonography for the Placement of Caudal Epidurals for Thoracic Surgery in Infants: A Description of the Technique and Case Series.

Caudal epidural catheters threaded to the thoracic levels are increasingly utilized in infants undergoing thoracic and abdominal surgery, compared to lumbar or thoracic epidural techniques. Estimating catheter length traditionally relies on anatomical landmarks, but the lack of spine ossification in infants makes ultrasonography a valuable and noninvasive tool. We present 3 cases where real-time ultrasonography facilitated caudal to thoracic epidural catheter placement in infants undergoing thoraco-abdominal surgeries. Incision-congruent placement of the catheter tip ensured effective perioperative analgesia with low doses of bupivacaine administered as intermittent boluses resulting in potent and prolonged analgesia with reduced opioid requirements.

The dilutional volume of morphine and xylazine administered via caudal epidural catheter affects cranial spread of analgesia in healthy standing horses.

To test the influence of increasing injectate volumes on the regional effects of xylazine and morphine epidural analgesia, with the hypothesis that increasing volume produces more cranial spread of analgesia as determined by thermal threshold (TT) testing. 6 university-owned research/teaching horses (2 mares, 4 geldings) deemed healthy on physical examination and basic lameness evaluation, aged 6-19 years and weighing 420-560 kg, were used in this prospective, randomized, blinded, cross-over experimental study. After routine placement of a caudal epidural catheter, all animals were subsequently instrumented with a TT testing system at the withers (Location A), the cranial (Location B), and caudal (Location C) abdominal area, over the tuber coxae (Location D), and the hind limb dorsal pasterns (Location E). All horses underwent five testing cycles with 0.2 mg/kg morphine and 0.2 mg/kg xylazine diluted to 20, 35, 50, 75, and 100 mL. TT testing was performed at 2, 4, 6, 8, and 10 hours by blinded investigators. With increased epidural volume, significantly greater cranial spread of analgesic effect was noted. All epidural volumes caused significant changes in TT testing at location E but only the largest volume resulted in a significant TT testing change at location A. Volume influences the regional effects of caudal epidural analgesia in horses but might affect analgesic reliability.

Caudal epidural catheterization for pain management in 48 hospitalized horses: A descriptive study of demographics, complications, and outcomes

The placement of caudal epidural catheters in horses has become more frequent as a multi-modal analgesic strategy. Despite its integration into clinical practice, there are limited reports describing the use of caudal epidural catheterization for prolonged use in horses. The purpose of this study was to characterize the hospitalized caseload undergoing epidural catheterization for long-term epidural analgesic administration, to report the response to epidural therapy and observed complications, and to describe patient outcomes. Medical records of hospitalized equine patients that underwent placement of a caudal epidural catheter for analgesic management between 2017 and 2021 were analyzed retrospectively. For the 62 catheters placed in the 48 cases, the most frequent diagnosis category prompting epidural analgesia was orthopedic (43/48, 89.6%). Synovial sepsis was the most frequent specific diagnosis prompting epidural catheter placement (11/48, 22.9%). The initial response to epidural therapy was characterized as positive for 37/62 (59.7%) catheters. Complications were documented for 46/62 (74.2%) catheters. However, most of these complications were classified as mild (51.6%) or moderate (14.5%), and exaggerated physiologic responses were observed most frequently. Of the horses studied, 52.1% survived to be discharged from the hospital. With awareness of potential complications and vigilant monitoring, caudal epidural catheters should be considered for equine patients as an analgesic strategy.

Caudal epidural blockades for chronic pain in the lower back in working age

Introduction. Chronic back pain syndrome, which significantly restricts a person’s daily activity, can cause the formation of depressive states and is a significantly more difficult task for treatment compared to acute pain.Aim. To evaluate the efficacy and safety of caudal epidural catheterization (CEC) and local therapy with anesthetics and glucocorticoids for chronic nonspecific discogenic and chronic radicular low back pain (LBP) in young and middle-aged patients.Materials and methods. 42 patients aged from 29 to 59 years, who in the neurosurgical department of the Vologda City Hospital No. 1 in 2017–2019 underwent an operation to install a caudal epidural catheter and prolonged injection therapy of local anesthetics and glucocorticosteroids for chronic nonspecific discogenic and chronic radicular LBP.Results. There were no purulent-septic complications, hematomas of the spinal canal. In the group of patients with radicular syndrome the average values of LBP according to VAS were as follows: before CEC – 78.5 mm; 5 days after CEC – 24.1 mm; 6 months after CEC – 19.6 mm; after 12 months – 17.9 mm. In the group of patients with nonspecific discogenic LBP the average pain estimates for VAS were as follows: before CEC – 78.1 mm; 5 days after CEC – 21.7 mm; 6 months after CEC – 20.9 mm; after 12 months – 23.4 mm.Сonclusion. Our experience indicates a high long-term efficacy and safety of treatment with caudal epidural catheterization and local prolonged therapy with anesthetics and glucocorticoids for chronic radicular and chronic nonspecific discogenic pain in the lower back in young and middle-aged patients selected on the basis of a special system of criteria.

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

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.

The Migration of Caudally Threaded Thoracic Epidural Catheters in Neonates and Infants

The migration of pediatric thoracic epidural catheters via a thoracic insertion site has been described. We assessed the migration of caudally threaded thoracic epidural catheters in neonates and infants at our institution. The anesthesia records and diagnostic imaging studies of neonates and infants who had caudal epidural catheters placed during a 26-month period at our hospital were analyzed. Imaging studies were reviewed for changes in epidural catheter tip position. Eighty-five patients 1-325 days of age (median, 51 days; interquartile range, 39-78 days) and weights of 2.5-9.5 kg (median, 5 kg; interquartile range, 4.3-5.8 kg) met the study criteria. Fifty-four (64%) of the patients (95% CI, 52%-73%) experienced catheter migration of 1 or more vertebral levels (range, 3 levels caudad [outward] to 3 levels cephalad [inward]), and 23 (27%) of the patients (95% CI, 18%-38%) experienced catheter migration to the T4 level or higher. Migration of 2 or more vertebral levels occurred only in children who weighed <6 kg and were under 73 days of age. Epidural catheter migration occurs commonly in neonates and infants. Postoperative imaging is crucial to confirm catheter tip location after epidural catheter placement, as failure to assess catheter migration might result in suboptimal analgesia or other undesirable outcomes.

Combined spinal/caudal catheter anesthesia: extending the boundaries of regional anesthesia for complex pediatric urological surgery

Spinal anesthesia (SA) is an established anesthetic technique for short outpatient pediatric urological cases. To avoid general anesthesia (GA) and expand regional anesthetics to longer and more complex pediatric surgeries, the authors began a program using a combined spinal/caudal catheter (SCC) technique. The authors retrospectively reviewed the charts of all patients scheduled for surgery under SCC between December 2016 and April 2018 and recorded age, gender, diagnosis, procedure, conversion to GA/airway intervention, operative time, neuraxial and intravenous medications administered, complications, and outcomes. The SCC technique typically involved an initial intrathecal injection of 0.5% isobaric bupivacaine followed by placement of a caudal epidural catheter. At the discretion of the anesthesiologist, patients received 0.5mg per kilogram of oral midazolam approximately 30min prior to entering the operating room. One hour after the intrathecal injection, 3% chloroprocaine was administered via the caudal catheter to prolong the duration of surgical block. Intra-operative management included either continuous infusion or bolus dosing of dexmedetomidine, as needed, for patient comfort and to optimize surgical conditions. Prior to removal of caudal catheter in the post-anesthesia care unit, a supplemental bolus dose of local anesthesia was given through the catheter to provide prolonged post-operative analgesia. Overall, 23 children underwent attempted SCC. SA was unsuccessful in three patients, and surgery was performed under GA. The remaining 20 children all had successful SCC placement. There were 11 girls and nine boys, with a mean age of 16.5 months (3.3-43.8). Surgeries performed under SCC included seven ureteral reimplantations, two ureterocele excisions/reimplantations, two megaureter repairs, four first-stage hypospadias repairs, one distal hypospadias repair, one second-stage hypospadias repair, two feminizing genitoplasties, and one open pyeloplasty. Average length of surgery was 109min (range 63-172min). Pre-operative midazolam was given in 13/20 (65%). All SCC patients were spontaneously breathing room air during the operation, and there were no airway interventions. Only one SCC patient received opioids intra-operatively. There were no intra-operative or perioperative complications. This pilot study shows that the technique of SCC allows one to do more complex urologic surgery under regional anesthesia than what would be possible under pure SA alone. The main limitations of the study include the relatively small number of patients and the small median length of the operative procedures. As a proof of concept, however, this does show that complex genital surgery bladder level procedures such as ureteral reimplantation can be performed under regional anesthesia. SCC allows for more complex surgeries to be performed exclusively under regional anesthesia, thus obviating the need for airway intervention, minimizing or eliminating the use of opioids, and thus avoiding known and potential risks associated with GA. The latter is of particular importance given current concerns regarding hypothetical neurocognitive effects of GA on children aged below 3 years.

Continuous caudal epidural analgesia and early feeding in delayed bladder exstrophy repair: a nine-year experience

Children undergoing primary closure of bladder exstrophy experience blood loss and significant fluid shiftsand require protracted periods of postoperative immobilization to avoid compromising the repair. Suboptimal anxiolysis and pain management is associated with increased morbidity. There is a lack of consensus on the optimal analgesic technique and studies have not previously described analgesic management in delayed bladder exstrophy closure. In exstrophy management, opioid infusions and benzodiazepine sedation are commonplace but are associated with dose-dependent respiratory and gastrointestinal side-effects. We present nine years of caudal epidural anaesthesia in delayed bladder exstrophy repair and describe its facilitation of early extubation and early feeding (within 12h) without surgical complication. We retrospectively evaluated consecutive infants with classic bladder exstrophy undergoing delayed primary closure with anterior pelvic osteotomies between November 2007 and January 2016. Outcomes and complications were evaluated in terms of postoperative comfort (using the FLACC score-Face, Legs, Activity, Cry, Consolability), epidural failure rate, re-intubation rateand gastrointestinal complications. Forty-four infants had average age of 5.8 months (range 1.6-17.1 months) and weight of 7.0kg (range 3.5-11.8kg), and their duration of surgery was 9.5h (range 6.9-14.3h). Forty-two of 44 (95.5%) patients received caudal epidural catheters. At 24h, 15 of 42 (35.7%) caudal epidurals required supplementation with intravenous opioids. Fewer patients with optimally functioning epidurals required postoperative ventilation (1/27 [3.7%] compared with 3/15 [20.0%]). None of the patients with caudal epidural catheters required re-intubation. Pain scores were lower in infants with isolated caudal epidurals catheters than those with caudal epidurals supplemented by intravenous opioids(day 1 [18 vs 53; P=0.008]; day 2 [8 vs 15; P>0.05] and overall [32 vs 65; P=0.014]). Infants with intravenous opioids experienced higher complications: pruritus (25% [95% confidence interval {CI}: 5%-57%] vs 0% [95% CI: 0%-13%]; P=0.026)and nausea and vomiting (25% [95% CI: 5%-57%] vs 8% [95% CI: 1%-25%]; P=0.30) requiring treatment. Nineteen of 44 (43.1%) infants were fed early (within 12h of surgery). Infants who were fed early had lower pain scores than infants feeding late(day 1 [17.5 vs 31; P>0.05]; day 2 [5.5 vs 15; P=0.045]; overall [26 vs 55.5; P=0.015]) without increase in complications (nausea and vomiting [6.3% vs 20.0%; P=0.06]; ileus [0.0% vs 0.0%]; aspiration [0.0% vs 0.0%]and re-intubation aspiration [0.0% vs 0.0%]). Caudal epidural analgesia facilitates postoperative extubation in infants undergoing delayed exstrophy repair. Early feeding (within the first 12h) in delayed bladder exstrophy repair is likely to improve patient comfort and consolability without increasing the incidence of gastrointestinal complications. Intravenous opioid may be associated with increased postoperative complications that may influence peri-operative outcomes.

Computer Navigated Percutaneous Sacroiliac Joint Screws Assisted by Caudal Epidural Contrast Injection

This article describes an innovative technique for effective analgesia and enhanced accuracy in placement of percutaneous sacroiliac screws in patients with unstable, posterior pelvic ring injuries. Our approach involves introducing radio-opaque contrast through an indwelling caudal epidural catheter to enhance existing computer navigation systems. This delineates the lumbosacral nerve roots to promote the safe and accurate placement of sacroiliac screws and concurrently provides effective analgesia. We describe the technique and our first cases. It can be used to supplement your current technique in placing sacroiliac joint screws and provide effective analgesia for our patients.

Does ultrasound guidance add accuracy to continuous caudal‐epidural catheter placements in neonates and infants?

Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserted under real-time ultrasound guidance may be more accurate than the accuracy of the measurements traditionally used for their placement. We studied 25 patients, aged 2 days to 5 months, posted for abdominal or thoracic surgery, receiving general anesthesia followed by caudo-epidural continuous block. External measurement defined as the distance from the caudal space and the surgically congruent vertebral level was measured in centimeters with the back gently flexed. Subsequently, a caudo-epidural block was performed in the same position. The epidural catheter insertion was followed under real-time ultrasound guidance till the predetermined vertebral level was reached. The actual length placed under real-time ultrasound scan was defined as the actual length. The high-frequency probe was placed longitudinal and paramedian to the spine. The vertebral level was determined by identifying the lumbosacral junction in longitudinal saggital view and counting the vertebrae up from L5. The catheter length at the skin was compared with the length recorded by external measurement. The actual length placed under real-time ultrasound scan were consistently longer than the external distance between the caudal space and selected vertebral level. The mean values of ultrasound were higher than the mean values of external measurement with a difference of 4.28 cm. Accuracy was not affected by age or affected by the selected vertebral level in the age group we studied. We conclude that catheters placed under ultrasound guidance are more accurate than the traditional method developed before the advent of ultrasound in young infants.

Comparison of epidural versus systemic analgesia for major surgeries in neonates and infants

Background and Aims: Postoperative analgesia in neonate reduces acute behavioral responses to pain. It also protects the developing nervous system from persistent sensitization of pain pathway and potential damaging effects of altered neural activity on central nervous system development. We compared the effectiveness of epidural versus systemic modes of analgesia for major surgeries in neonates and infants. Materials and Methods: This randomized, single center, prospective, controlled study was conducted in sixty patients, aged 1 day to 6 months, weighing 2–5 kg belonging to the American Society of Anesthesiology physical Grade II to IV, posted for major thoracic and abdominal surgery. After general anesthesia, in Group A, the epidural catheter was inserted through standard caudal epidural technique. Initial bolus of 0.125% bupivacaine (0.75 ml/kg) and postoperatively caudal infusion of 0.0625% bupivacaine (0.1 ml/kg/h) was given. Intraoperatively Group B received fentanyl (1–2 μg/kg) and paracetamol (10 mg/kg) intravenously and postoperatively paracetamol (10 mg/kg)/intravenous (IV) six hourly or pain score > 4. Postoperative pain was assessed using face, legs, activity, cry, and consolability pain scale and sedation score was assessed by using four-point sedation score for 48 h. Results: Patients in Group A remained hemodynamically stable except occasional bradycardia below 100 which was successfully managed with anticholinergics. There was less requirement of sevoflurane in the intraoperative period and good quality of analgesia. While in Group B, multiple and regular dosage of IV paracetamol was required to maintain adequate analgesia. Conclusion: Very efficient postoperative analgesia can be achieved via caudal epidural catheter in combination with general anesthesia compared to IV paracetamol in neonates and infants.

Changes of epidural blood flow after epidural administration of epinephrine in young rats.

For caudal epidural analgesia, the needle is inserted at a site where vessels are abundant. To avoid complications related to intravascular administration of the local anesthetic, epinephrine is usually added, but there is no evidence about the safety of epidural administration of epinephrine in pediatric patients. The objective of this study was to assess the changes in epidural blood flow after epidural injection of epinephrine in young rats. With approval of the local ethics committee, four young Sprague-Dawley rats weighing 110-120g were investigated. The rats were anesthetized with isoflurane via a mask. After there was no escape reaction to pain, an arterial catheter, epidural blood flow monitor (Laser Doppler blood flow ALF 21; ADVANCE Corp.), and caudal epidural catheter were inserted while the rats remained under general anesthesia. Exactly, 10μl of 1 : 1000 epinephrine was then infused, followed by measurement of the blood pressure and epidural blood flow. After the recovery of the blood pressure and epidural blood flow to baseline, 10μl of saline was infused through the epidural catheter. The blood pressure and epidural blood flow were then measured again. One rat was excluded because epinephrine was inadvertently injected into the epidural vessels. Therefore, three rats were investigated in this experiment. Blood flow in the epidural space showed no change after the injection of saline. When epinephrine was administered into the epidural space, epidural blood flow decreased immediately and low flow persisted for 6-15min. The reduction of blood flow was not very great, being only 8-14%, so there was no risk of spinal ischemia which would require 60-80% reduction. Administration of epinephrine into the epidural space was safe in young rats. While reduction of epidural blood flow was observed, there was no spinal ischemia.

A New Technique for Long Time Catheterization of Sacral Epidural Canal in Rabbits

IntroductionIn this study we aimed to develop a simple and practical technique for chronic sacral epidural catheterization of rabbits. MethodsWe included ten rabbits weighing 2-2.5kg in the study. After anesthesia and analgesia, we placed an epidural catheter by a 2cm longitudinal skin incision in the tail above the sacral hiatus region. We confirmed localization by giving 1% lidocaine (leveling sensory loss and motor function loss of the lower extremity). The catheter was carried forward through a subcutaneous tunnel and fixed at the neck. ResultsChronic caudal epidural catheter placement was succesful in all rabbits. The catheters stayed in place effectively for ten days. We encountered no catheter complications during this period. The localization of the catheter was reconfirmed by 1% lidocaine on the last day. After animals killing, we performed a laminectomy and verified localization of the catheter in the epidural space. ConclusionsVarious methods for catheterization of the epidural space in animal models exist in the literature. Epidural catheterization of rabbits can be accomplished by atlanto-occipital, lumbar or caudal routes by amputation of the tail. Intrathecal and epidural catheterization techniques defined in the literature necessitate surgical skill and knowledge of surgical procedures like laminectomy and tail amputation. Our technique does not require substantial surgical skill, anatomical integrity is preserved and malposition of the catheter is not encountered. In conclusion, we suggest that our simple and easily applicable new epidural catheterization technique can be used as a model in experimental animal studies.

Thoracotomy in a spontaneously breathing neonate undergoing tracheo-oesophageal fistula repair

Tracheo-oesophageal fistulae present a unique ventilator problem in the neonatal population. We describe the use of a caudal epidural catheter in a neonate who had to undergo carinal tracheo-oesophageal fistula repair. The epidural administration of a local anaesthetic enabled the provision of optimal analgesia, while simultaneously allowing maintenance of comfortable spontaneous ventilation during the thoracotomy.

Continuous caudal epidural anaesthesia for vaginal hysterectomy in a patient of heart disease and severe spinal deformity; a case report

We present this case report where we have used fluoroscopic localization of caudal space and caudal epidural catheter placement to conduct caudal epidural anaesthesia in a case of vaginal hysterectomy and colporrhaphy with co-morbidity of severe spinal deformity, valvular heart disease and pulmonary hypertension.

Cephalad Migration of Pediatric Caudal Epidural Catheters Associated with Change from Prone to Supine Position

RADIOPAQUE epidural catheters are inserted at a caudal location and threaded cephalad with the patient in the lateral decubitus or prone position. Each catheter tip location is confirmed via fluoroscopy or epidurogram1and then the catheter is secured with sterile dressing and Dermabond®(Ethicon Inc., Somerville, NJ).2We recently found radiographic evidence of cephalad migration of a caudal epidural catheter tip in a pediatric patient after a position change, despite unchanged catheter skin depth.The figure shows the catheter tip in a patient in the prone (fig. A, T6 level, at insertion in the operating room) and supine (fig. B, T2/T3 level, 60 min postinsertion in the neonatal intensive care unit) positions. Proper catheter tip position had been confirmed in the prone position using fluoroscopy. Although the catheter remained secured at its initial skin depth in the caudal region, postoperative supine radiographs showed the catheter tip had migrated cephalad to the T2/T3 level. Cephalad migration not only resulted in the catheter providing inadequate analgesia, but also increased the risk of undesirable side effects (e.g. , cardiac accelerator fiber blockade). The catheter was withdrawn and provided good postoperative analgesia after its tip was reconfirmed at the desired level in the supine position.Based on this finding, we now confirm the locations of caudally threaded epidural catheters with the patient in the supine position.

Comparison of Analgesic Effects of Caudal Epidural 0.25% Bupivacaine with Bupivacaine Plus Morphine or Bupivacaine Plus Ketamine for Analgesia in Conscious Horses

The aim of this study was to compare the effects of caudal epidural bupivacaine alone (BP), bupivacaine plus morphine (BPMP), and bupivacaine plus ketamine (BPKE) for perineal analgesia in horses. Each of the six saddle horses received a caudal epidural catheter and underwent 3 treatments: BP, 0.25% (0.04 mg/kg) bupivacaine hydrochloride without epinephrine; BPMP, 0.02 mg/kg of bupivacaine combined with 0.1 mg/kg of morphine-preservative free; and BPKE, 0.02 mg/kg of bupivacaine combined with 0.5 mg/kg of ketamine. The order of treatments was randomized. The cardiovascular system, respiratory rate, quality of analgesia, sedation, and motor blockade were assessed before drug administration (baseline), at 5, 10, 15, and 30 minutes, and every 30 minutes thereafter until loss of analgesia. The median time to onset of analgesia was 5 minutes after BP treatment, faster than after BPKE or BPMP treatments, which were 10 minutes and 15 minutes, respectively (P < .05). The BPMP treatment produced analgesia (315 minutes) for a longer duration than BP treatment (210 minutes) or BPKE treatment (240 minutes), in the regions of the tail, perineum, and upper hind limb in horses. All treatments presented mild sedation or motor blockade. There were minimal effects on the cardiovascular system and respiratory rate. BPMP may be preferable to a high dose of BP or BPKE. Caudal epidural BPMP can be an appropriate choice for regional perineal analgesia in horses.

Caudal Cannula as an alternative to Caudal Epidural Catheter for Prolonged Analgesia

Caudal Cannula as an alternative to Caudal Epidural Catheter for Prolonged Analgesia

Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair

Objective Reconstruction of bladder exstrophy in newborn infants requires immobilization, sedation and pain management to prevent distracting forces from compromising the repair. We present a 6-year review of our experience. Subjects and methods We reviewed the perioperative management of newborn infants undergoing reconstruction between November 1999 and October 2006. Data are presented as means ± SD. Results Twenty-three newborn infants underwent surgery under a combined epidural and general anesthetic technique. Tunneled caudal epidural catheters were inserted in all patients and intermittently injected with 0.25% bupivacaine with 1:200,000 epinephrine. Postoperatively, a continuous infusion of 0.1% lidocaine, 0.8–1 mg/kg/h was administered for 15 ± 8 (range 4–30) days. Children were sedated with diazepam for 20 ± 13 (range 2–40) days. Central venous catheters were maintained for 20 ± 9 (range 1–34) days for fluids, drug administration and blood sampling. No patient experienced bladder prolapse or wound dehiscence. Conclusion Perioperative management with tunneled epidural and central venous catheters in newborn infants with bladder exstrophy facilitates immobilization, analgesia and sedation, resulting in an excellent cosmetic repair with no case of bladder prolapse or wound dehiscence.

Combined spinal – epidural anesthesia in major abdominal surgery in high‐risk neonates and infants

Combined spinal-epidural anesthesia (CSE-A) is reportedly safe and effective for the pediatric population in infraumbilical surgery. Our main purpose was to describe our experience of this technique in neonates and infants undergoing elective major upper abdominal surgery. Spinal anesthesia was performed in 28 neonates and infants with isobaric bupivacaine 0.5%, 1 mg.kg(-1) followed by placement of a caudal epidural catheter to thoracic spinal segments. The catheter tip position was confirmed radiographically. Respiratory and hemodynamic data were collected before and after the CSE-A and throughout the operation, as a measure of anesthetic effectiveness. Complications related to the anesthesia technique were collected as a measure of the anesthetic technique safety. Satisfactory surgical anesthesia was achieved in 24 neonates and infants, four patients were converted to general anesthesia. Respiratory and hemodynamic variables did not change significantly during surgery, compared with baseline values: oxygen saturation (P = 0.07), systolic and diastolic blood pressures (P = 0.143, P = 0.198 respectively), heart rate (P = 0.080) and respiratory rate (P = 0.127). However, twenty infants were fussy during the surgical procedures and were calmed with intravenous midazolam; our patients required oxygen supplementation and transient manual ventilation intraoperatively. Combined spinal-epidural anesthesia could be considered as an effective anesthetic technique for elective major upper abdominal surgery in awake or sedated neonates and infants, and could be used cautiously by a pediatric anesthesiologist as an alternate to general anesthesia in high-risk neonates and infants undergoing upper gastrointestinal surgery.