[A comparison of ultrasonography versus traditional approach for caudal block in children].
OBJECTIVE
To apply ultrasonic technology in positioning and monitoring for pediatric caudal blocks and compare it with traditional landmark approach and Swoosh test.


METHODS
After obtaining the approval of hospital ethics committee and written parental informed consent, a total of 102 American Society of Anesthesiologists (ASA) I-II pediatric patients aged from 1 month to 8 years and scheduled for urologic or perineal surgery were recruited. Patients were randomly divided into 2 groups: ultrasound group (n = 52) and control group (n = 50). The sites of sacral cornu and sacral hiatus were determined by ultrasonic imaging or classic method of anatomical surface landmarks. Patients of two groups were punctured according to the scheduled site. Local anesthetic was injected slowly into caudal space after a successful caudal puncture and the positive reaction in caudal space was monitored simultaneously by ultrasound and classic swoosh test. The observational results and relevant date were recorded.


RESULTS
In ultrasound and control groups, the number of puncture attempts was 1.10 ± 0.30 vs 1.56 ± 0.63, the duration of puncture (1.40 ± 0.39) vs (3.23 ± 1.23) min, the success rate at the first puncture attempt 90.4% vs 66% and the total puncture success rate 100% vs 92% respectively. After the injection of local anesthetic, the positive reaction rate of ultrasonography and swoosh test was 97.96% vs 62.24% respectively. All of above results in ultrasound group were superior to those in control group or with classic test. And the difference had statistical significance (P < 0.01).


CONCLUSIONS
Ultrasonic positioning and monitoring for pediatric caudal block is both scientific and reasonable. The positioning detected by ultrasonic imaging is accurate and the monitoring results of ultrasound are reliable. It is obviously superior to traditional method and has clinical application values for caudal block in children.
Department of Anesthesiology, Tianjin Children's Hospital, Tianjin 300074, China. drljzh@sina.com
Jin-zhu
JZ
Liu
Xue-qing
XQ
Wu
Rong
R
Li
Yan-jun
YJ
Zhang
D000763:Anesthesia, Caudal / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012447:Sacrum; D014463:Ultrasonography