Caudal blocks

[urge]

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Seems to me facing the back is the natural way to go but some attendings at my place teach the resident to do it from the other side (facing pts belly).

Would you do a spinal from the side of the belly? Makes no sense to me.

How are you guys being taught? Facing the child's back, or facing the belly?

 

[sevoflurane]

I always have done them lateral... in the fetal position (knees up to the chest).

Kinda like this... but the pedi version:

 

[urge]

I always have done them lateral... in the fetal position (knees up to the chest).

Kinda like this... but the pedi version:

I do them like that, with me facing the back of the pt.(me being the person taking the picture).

I have some residents (because that's what they are being taught) who want to be on the other side of the bed, facing the belly, and then crawl up the child to get to the back. It would be as if the guy in scrubs in your picture were doing the caudal.

 

[urge]

Picasso ain't got nothing on me.

 

[sevoflurane]

Picasso ain't got nothing on me.

That has to be the picture of the year urge. You've surpased pent, sux, tube.

I clearly misunderstood your question, thanks for the awesome rendition. 👍

I need to add one of these.. 🤣 and one of these 😆

 

[IlDestriero]

For a simple caudal in a small child, I face the belly, reach over and place it. I do it that way because I have them turn on their right side facing the vent and I'm right handed. If I turn them the other way I'd do it from the back. I'm quite tall and have long arms. It's just as easy either way. When I'm with a short trainee, I have them face the back and turn the kid the other way. I have no idea how that started, but by turning toward the vent I don't have to reposition the vent tubing. I guess I'm lazy, and dislike unnecessary steps.🙂

 

[pgg]

Picasso ain't got nothing on me.

You should make that your avatar.

 

[periopdoc]

I use the belly to belly reach over technique. It feels more natural to me, I feel like it is easier for me to hold the child in the right position this way, and I don't have to worry about somebody deciding that just about the time I get the needle inserted is the best time for examining the belly or an extremity and blowing my block.

I am ambidextrous with all of my blocks so it doesn't matter to me which way the child is facing. Reach over with the left or the right hand. Whichever is caudad on the patient.

Oh yeah, I am 6'2" so visualization is not a problem.
-pod

 

[lauderdoc]

For peds anesthesia I have always done them facing the child's abdomen and reaching over but I am 6-1 so a lot of people may do well with a different technique. For chronic discogenic pain standard of care is to lie pt prone and use C-arm and epidurogram.

 

[Gern Blansten]

Picasso ain't got nothing on me.

***Like***

 

[Gern Blansten]

I use the belly to belly reach over technique. It feels more natural to me, I feel like it is easier for me to hold the child in the right position this way, and I don't have to worry about somebody deciding that just about the time I get the needle inserted is the best time for examining the belly or an extremity and blowing my block.

I am ambidextrous with all of my blocks so it doesn't matter to me which way the child is facing. Reach over with the left or the right hand. Whichever is caudad on the patient.

Oh yeah, I am 6'2" so visualization is not a problem.
-pod

I do them from behind the patient, but I can see the advantages to the way you describe. I would probably pull them slightly past perpendicular lateral ( towards prone ) to improve the view. I could see that this may give you better positional control and would not really require a second person on the other side to make sure the patient did not fall off the bed (at my place, they are frequently done post op as we are lightening the anesthetic, so movement is a higher possibility).
I have not done as much pedi in the last 2 years, so I am not sure what the most common practice is at my place currently. I do lots of regional and I think I could quickly become comfortable with the abdomen to abdomen approach.

 

[Jay K]

I learned to do them belly-to-belly as well.

 

[ranvier]

I like the reach around unless a really big kid.

 

[deleted162650]

I like the reach around unless a really big kid.

I think that's what Sandusky said