clinical Application of Pediatric Caudal Anesthesia

Nam, Yong Taek; Kim, Won Oak; Park, Kwang Won; Cho, Chung Hyun

Abstract

Although regional anesthesia has many advantages over general anesthesia it is not so popular in pediatric patient because of (1) anatomic difference with that of adult (2) lack of patient cooperation (3) difficulty for determination of local anesthetic amount. Among many kinds of regional anesthesia caudal anesthesia is simple, high success rate and needless patient's cooperation with lesser complications. We tried caudal anesthesia in 103 patients from birth to 10 years old children for operation below the inguinal region. We injected 1% lidocaine 10 mg/kg or less for short procedure and 1% lidocaine with 0.5% bupivacaine with 1:1 mixture at the same volume with that of 1% lidocaine only. Thr results were as follows: 1) Pediatric caudal anesthesia is simple and easy with high success rate (more than 93%). 2) There was one case of systemic onvulsion after lidocaine injection and it seemed to be due to multiple blood aspiration during caudal puncture rather than lidocaine overdose. 3) Four children revealedbradycardia below 70% of control heart rate. This bradycardia probably due to cardiac toxicity of bupivacaine because all of the bradycardia children used bupivacaine. 4) Poor risk children for general anesthesia such as upper respiratory tract infection, abnormal liver function test or congenital heart disease were sixteen among 103 children, and they all proceeded operative procedure without event. 5) Postoperative pain control was excellent in caudal anesthesia than general anesthesia according to pain-discomfort scale with 1 point vs 6 points at recovery room. With the above results we consider that pediatric caudal anesthesia is a safe and useful procedure with lesser complication especially in poor risk children.