A Comparison Of Efficacy Of Ultrasound Guided Versus Traditional Approach For Caudal Epidural Anaesthesia In Paediatric Patients- A One Year Hospital Based Randomised Controlled Trial

Abstract

Background and objective: Caudal anaesthesia is the most frequently performed regional anaesthetic technique in children. In the traditional method location of caudal epidural space is difficult and the puncture attempts needed are also more. Ultrasound can help to identify the caudal epidural space precisely, with lesser number of punctures and fewer complications. This randomized controlled trial was done to evaluate the efficacy of ultrasound guided versus traditional method of caudal block in paediatric age group. Methods: 70 ASA I–II children undergoing elective infraumbilical surgeries under caudal epidural block were randomly allocated to one of the two groups – traditional method and whoosh test (group A) or ultrasound guided caudal block (group B). Success rate of block, puncture frequency, complications were analysed. A p value of < 0.05 was considered significant. Results: The success rate of block was similar between two groups (31of 35 children in group A vs 35 of 35 in group B, p=0.12). The first puncture success rate was higher in group B than in group A (33 of 35 vs 10 of 35 respectively p<0.05). Second attempt was required in 20 of 35 patients in Group A as compared to 2 of 35 patients in Group B. In group A, 5 patients required third attempt while none in Group B required more than two attempts. None of the complications like bloody puncture, dural puncture, subcutaneous bulging were noted in either group. Conclusion: Ultrasound can be used as an adjuvant tool in performing caudal epidural block as it provides real-time images in guiding the needle into the caudal epidural space with fewer complications and lesser number of punctures with higher success rate as compared to traditional method of caudal block and whoosh test.