• Maya Keplinger, Peter Marhofer, Wolfgang Klug, Birgit Reiter, Thomas Stimpfl, Stephan C Kettner, Lena Korf, Markus Zeitlinger, Daniela Marhofer, and Lydia Triffterer.
• Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
• Paediatr Anaesth. 2016 Nov 1; 26 (11): 1053-1059.

BackgroundCaudal blockade, although an important technique of pediatric regional anesthesia, is rarely used in children heavier than 30 kg. This reservation is due to anatomical concerns and lack of pharmacokinetic data. We therefore set out to evaluate, in pediatric patients weighing 30-50 kg, the feasibility of ultrasound-guided caudal blockade and the pharmacokinetics of caudally administered ropivacaine.MethodsTwenty consecutive children were included. General anesthesia was used to ensure a secured airway. For the caudal punctures, we applied the same clinical standards as in smaller children, administering ropivacaine 3.1 mg·ml-1 for a volume of 1 ml·kg-1 via ultrasound guidance. Pharmacokinetic analysis was based on total plasma ropivacaine levels and included maximum concentration (Cmax ), time to Cmax (tmax ), terminal elimination half-life, area under the concentration-time curve for the 4-h sampling period, apparent total body clearance, and apparent volume of distribution.ResultsIn all 19 cases of successful puncture, we identified the relevant anatomical structures (sacral cornua, sacral hiatus, dura mater) and verified correct administration of the local anesthetic by visualizing its cranial spread. Surgical blockade was successful in 18 of 20 cases (90%; one puncture was technically not possible and one child received intraoperatively 50 μg fentanyl). The pharmacokinetic profile of the administered ropivacaine 3.1 mg·ml-1 indicated plasma levels within safe ranges in pediatric patients weighing 30-50 kg.ConclusionsBased on our pharmacodynamic and pharmacokinetic results, we suggest that the body weight of 50 kg it is feasible to perform effective and safe caudal blockade in children up to 50 kg body weight.© 2016 John Wiley & Sons Ltd.

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