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Anesth Analg. 2019 Feb 27. doi: 10.1213/ANE.0000000000004067. [Epub ahead of print]

Real-Time Ultrasound Improves Accuracy of Caudal Block in Children.

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From the Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Dan L. Duncan Institute for Clinical and Translation Research, Baylor College of Medicine, Houston, Texas.



Caudal block, the most common regional anesthetic in children, is predominantly performed using palpation to determine placement. The efficacy of the palpation technique is unknown with respect to block success. While ultrasound has been suggested for use during caudal block, its use is infrequent.


A single-blinded prospective observational trial was performed evaluating provider success rate of caudal blocks placed by palpation alone. After needle insertion and partial local anesthetic injection, an ultrasound was performed to confirm correct location.


A total of 109 caudal blocks were performed during the prospective observational study. Success rate for caudal blocks done by palpation alone was 78.9% as confirmed by ultrasound. In 21.1% of caudal blocks, the provider incorrectly judged the needle to be in the caudal space as confirmed with ultrasound.


Real-time ultrasound visualization of local anesthetic injection provides reliable and immediate confirmation during caudal block in children.

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