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Peds anesthesia: caudals
Started by somedumbDO
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1mL/kg of .25% bupivacaine for outpatients, 1mL/kg of .25% bupivacaine with 1mcg/kg of clonidine for inpatients. I know studies show that clonidine is safe but I don't use it on outpatients because of concern of too much sedation with addition of oral opioids in a non-monitored setting.
Straight bupivacaine seems to last 5-6hrs and you can pretty reliably double that with the clonidine.
I'll do caudals for hernia repairs, ostomy takedowns, femoral fractures (amazing how it helps kids transition to SPICA casts...just have to make sure they leave enough room to access the hiatus in a sterile fashion)...as well as liberally in the urologic population.
TAP vs. Epidural vs. Paravertebral are decided on a case by case basis...they all work fine but varying operative circumstances and surgeon/family expectations keep me utilizing each of them with some frequency. It doesn't get much easier/faster than a caudal, so I suspect that they will always have a place in my practice for non-urologic surgeries.
Straight bupivacaine seems to last 5-6hrs and you can pretty reliably double that with the clonidine.
I'll do caudals for hernia repairs, ostomy takedowns, femoral fractures (amazing how it helps kids transition to SPICA casts...just have to make sure they leave enough room to access the hiatus in a sterile fashion)...as well as liberally in the urologic population.
TAP vs. Epidural vs. Paravertebral are decided on a case by case basis...they all work fine but varying operative circumstances and surgeon/family expectations keep me utilizing each of them with some frequency. It doesn't get much easier/faster than a caudal, so I suspect that they will always have a place in my practice for non-urologic surgeries.
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Penile blocks for circs; caudals for most urological cases...unless the kids are at an age where being unable to move their legs may be upsetting postoperatively.
Have had good success with ultrasound guided ilioinguinal blocks for orchiopexy (may be tough to find the actual nerve so I essentially do a TAP block in the area where I expect the nerve to lie)
For caudals...usually 1 ml/kg of 0.25% bupivacaine with 1:200 000 epi or 1 ml/kg of 0.2% ropivacaine with 1:200 000 epi. Our institution does not have clonidine easily available for neuraxial use..otherwise I would definitely use it!
Have had good success with ultrasound guided ilioinguinal blocks for orchiopexy (may be tough to find the actual nerve so I essentially do a TAP block in the area where I expect the nerve to lie)
For caudals...usually 1 ml/kg of 0.25% bupivacaine with 1:200 000 epi or 1 ml/kg of 0.2% ropivacaine with 1:200 000 epi. Our institution does not have clonidine easily available for neuraxial use..otherwise I would definitely use it!
Of all the cases that you mentionned i'd only maybe do a caudal for femoral fractures if for some reason i did't want to do a femoral block.
Caudal block are really inferior to other techniques imho
I agree. I rarely use it caudal unless it's a hypospadias repair proximal urologic. As far as technique 1/8 Marcaine with epi plus 2 mg/kg clonidine. With the advent of Decadron and peripheral nerve blocks I've seen recently in literature to suggest Decadron in the caudal space may extend duration block. Anyone currently using Decadron or any other adjuncts other than clonidine?j
