title: Caudal epidural blockade for major orthopedic hip surgery in adolescents.
abstract: BACKGROUND
  There continues to be a significant focus on the value of regional and neuraxial anesthesia techniques for adjunctive use when combined with general anesthesia. The reported advantages include decreased patient opiate exposure, decreased medication-related adverse effects, decreased postanesthesia recovery room time and hospital stay, and increased patient satisfaction.
  
  
  METHODS
  The authors present a case-controlled series evaluating the use of a single caudal epidural injection prior to incision as an adjunct to general anesthesia for the open repair of slipped capital femoral epiphysis. Opiate consumption, pain scores, and hospital stay were compared between the two cohorts of 16 adolescent patients. All patients received a demand-only patient-controlled opiate delivery system.
  
  
  RESULTS
  Although the failed block rate was high (31%), there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block. Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block.
  
  
  CONCLUSIONS
  The potential utility of caudal epidural block as an adjunct to general anesthesia during major hip surgery in adolescents is presented. Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.
authors.affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Schloss
authors.affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio, United States.
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.affiliation: The Ohio State University College of Medicine, Columbus, Ohio, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tripi
authors.affiliation: Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States.
authors.forename: Kevin
authors.initials: K
authors.lastname: Klingele
authors.affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio, United States.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
keywords: Adolescents; adults; caudal epidural
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