• Karen R Boretsky, Carlos Camelo, David B Waisel, Veronique Falciola, Cornelius Sullivan, Elena Brusseau, Elizabeth Eastburn, Andrea Gomez-Moraz, and Wasin Luckanavanich.
• Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
• Paediatr Anaesth. 2020 Jun 1; 30 (6): 671-675.

BackgroundCaudal epidural anesthesia is a frequently performed regional anesthesia block in infants and young children. Traditional landmark-based blind needle insertion remains the norm with no immediate, objective method to determine the presence of local anesthetic in the epidural space. Increasingly, ultrasound-imaging is used in pediatric regional anesthesia with demonstrated improvements in block efficacy and efficiency. The value of ultrasound-imaging in confirming success rate of traditional caudal placement is not well defined.AimTo assess the success rate of conventional landmark-based caudal technique using ultrasound-imaging.MethodsProspective observational study of 30 children ages 1 month to 7 years undergoing surgical procedures with consent for caudal blockade. Provider success rate of caudal blockade placed by landmark technique was measured using ultrasound-imaging of needle tip and local anesthetic flow in the epidural space.ResultsUltrasound-imaging demonstrated 80% success to correct positioning of the needle tip and local anesthetic in the epidural space. Failure was associated with decreasing experience and presence of anatomic variances. All improperly positioned needles were subsequently successfully positioned using real-time ultrasound-imaging. Mean time for confirmatory ultrasound-imaging (SD; range) was 1 minute (0.3; 1-3).ConclusionThe use of ultrasound-imaging can be used to identify proper needle placement in the sacral epidural canal and facilitate subsequent corrected placement.© 2020 John Wiley & Sons Ltd.

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