Continuous Caudal Catheters in Neonatal Population: A Focussed Review

Vol 2 | Issue 2 | July-December 2021 | Page 124-130 | Vrushali Ponde, Kriti Puri, Nandini Dave

DOI: 10.13107/ijra.2021.v02i02.040


Authors: Vrushali Ponde [1], Kriti Puri [2], Nandini Dave [3]

[1] Department of Anaesthesia, Surya Children Anaesthesia Services, Mumbai, Maharashtra, India.
[2] Department of Anaesthesia, Ganga Hospital, Coimbatore, Tamil Nadu, India.
[3] Department of Anaesthesia, NH SRCC Children’s Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Vrushali Ponde,
Consultant Paediatric Anaesthesiologist, Surya Children Anaesthesia Services, Mumbai, Maharashtra, India.
E-mail: vrushaliponde@yahoo.co.in


Abstract


Caudal epidural block is one of the most commonly administered blocks in paediatric population. Continuous caudal technique offers several advantages like its ability to cater to long duration surgeries, higher thoracic procedures and to deliver extended, titratable post-operative pain relief. Current advances in this technique like use of fluoroscopy, electrical stimulation and Ultrasound to secure continuous caudal catheters facilitate enhanced accuracy and safety and should be adopted wherever feasible. An understanding of local anaesthetic dosages for infusion and their fine tuning is a prerequisite. The potential benefits and risks should be assessed on a case-to-case bases
Keywords: Caudal anaesthesia, Post-operative pain, Neonatal regional anaesthesia


References


1. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019 Apr;122(4):509-517.
2. Bosenberg AT, Bland BAR, Schulte-Steinberg O, Downing JW. Thoracic epidural anaesthesia via the caudal route in infants. Anaesthesiology 1988;69:265-9.
3. Kil HK. Caudal and epidural blocks in infants and small children: historical perspective and ultrasound-guided approaches. Korean J Anesthesiol. 2018;71(6):430-439. doi:10.4097/kja.d.18.00109.
4. Simpao A, Gálvez J, Wartman E, England W, Wu L, Rehman M et al. The Migration of Caudally Threaded Thoracic Epidural Catheters in Neonates and Infants. Anesthesia & Analgesia. 2019;129:477-481.
5. Baidya D, Pawar D, Dehran M, Gupta A. Advancement of epidural catheter from lumbar to thoracic space in children: Comparison between 18G and 23G catheters. Journal of Anaesthesiology Clinical Pharmacology. 2012;28:21.
6. Ponde VC, Bedekar VV, Desai AP, Puranik KA. Does ultrasound guidance add accuracy to continuous caudal epidural catheter placements in neonates and infants? Paediatr Anaesth. 2017 Oct;27(10):1010-1014.
7. Bachman SA, Taenzer AH. Thoracic caudal epidural catheter localization using ultrasound guidance. Paediatr Anaesth. 2020 Feb;30:194-195.
8. Daftary S, R Jagtap. Caudal epidural as a sole anaesthetic in preterm, former preterm and high-risk infants. Indian J. Anaesth. 2005;49:195-198.
9. Uguralp S, Mutus M, Koroglu A, Gurbuz N, Koltuksuz U, Demircan M. Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: Experience in 1,554 children. J Pediatr Surg. 2002 ;37:610-3.
10. Raghavendran S, Diwan R, Shah T, Vas L. Continuous caudal epidural analgesia for congenital lobar emphysema: a report of three cases. Anaesth Analg. 2001Aug;93:348-50.
11. Carolis MPD, Bersani I, Piersigili F et al. Peripheral nerve blockade and neonatal limb ischemia: Our experience and literature review. Clinical and applied thrombosis/ haemostasis. 2014 Jan:55-60.
12. Luz G, Ladner E, Innerhofer P, Deusch E. Accidents following extradural analgesia in children. The results of a retrospective study. Paediatr Anaesth 1995;5:273.
13. McNeely J, Faber N, Rusy L, Hoffman G. Epidural analgesia improves outcome following paediatric fundoplication: a retrospective analysis. Reg Anaesth 1997; 22: 16-23.
14. Lin, Y.C, Sentivany Collins S.K, Peterson K.L, Boltz M.G and Krane E.J. Outcomes after single injection caudal epidural versus continuous infusion epidural via caudal approach for postoperative analgesia in infants and children undergoing patent ductus ligation. Paediatr Anaesth 1999; 9:134-143.
15. Bosenberg A. Benefits of regional anesthesia in children. Paediatr Anaesth. 2012 Jan;22:10-8.
16. Koo BN, Hong JY, Song HT, Kim JM, Kil HK. Ultrasonography reveals a high prevalence of lower spinal dysraphismin childrenwith urogenital anomalies. Acta Anaesthesiol Scand. 2012;56:624–8.
17. Tsui BC, Seal R, Koller J. Thoracic epidural catheter placement via the caudal approach in infants by using electrocardio- graphic guidance. Anesth Analg. 2002;95:326–330.
18. Tsui BC, Seal R, Koller J, Entwistle L, Haugen R, Kearney R. Thoracic epidural analgesia via the caudal approach in pediat- ric patients undergoing fundoplication using nerve stimulation guidance. Anesth Analg. 2001;93:1152–1155.
19. Tobias J.D. Caudal epidural block : Review of test dosing and recognition of systemic injection in children. Anaesth Analg. 2001;93:1156-61.
20. Suresh S, Ecoffey C, Bosenberg A, et al. The European society of regional anaesthesia and pain therapy/American society of regional anesthesia and pain medicine recommendations on local anesthetics and adjuvants dosage in pediatric regional anesthesia. Reg Anesth Pain Med 2018; 43: 211-6.
21. Gibbs A, Kim SS, Heydinger G, Veneziano G, Tobias J. Postoperative Analgesia in Neonates and Infants Using Epidural Chloroprocaine and Clonidine. J Pain Res. 2020;13:2749-2755.
22. Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anaesthesia in children: a one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists. Anaesth Analg 1996; 83:904 912.
23. Suresh, Santhanam MD*; Long, Justin MD*; Birmingham, Patrick K. MD*; De Oliveira, Gildasio S. Jr MD, MSCI† Are Caudal Blocks for Pain Control Safe in Children? An Analysis of 18,650 Caudal Blocks from the Pediatric Regional Anesthesia Network (PRAN) Database, Anaesth Analg. 2015< 120 151-156.
24. Breschan C, Krumpholz R, Jost R, Likar R. Intraspinal haematoma following lumbar epidural anaesthesia in a neonate. Paediatr Anaesth 2001; 11:105 –108.
25. Apthorp M, Challands J, Visram A. A survey of the usage of caudal catheters amongst paediatric anaesthetists practising in the UK [Abstract]. Paediatr Anaesth 2000; 10:692.
26. Walker SM, Yaksh TL. Neuraxial analgesia in neonates and infants: a review of clinical and preclinical strategies for the development of safety and efficacy data. Anesth Analg. 2012;115(3):638-662. )
27. Lejus C, Surbled M, Schwoerer D, et al. Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases. Paediatr Anaesth 2001; 11:327-332.
28. Breschan C, Krumpholz R, Likar R, et al. Can a dose of 2 mg kg71 caudal clonidine cause respiratory depression in neonates? Paediatr Anaesth 1999; 9:81-83.
29. Bouchut JC, Dubois R, Godard J. Clonidine in preterm-infant caudal anesthesia may be responsible for postoperative apnea. Reg Anesth Pain Med 2001; 26:83-85.
30. Wood CE, Goresky GV, Klassen KA, et al. Complications of continuous epidural infusions for postoperative analgesia in children. Can J Anaesth 1994; 41:613-620.
31. Boos K, Beushausen T, Ohrdorf W. Peridural catheter for postoperative long- term analgesia in children. AnaÈ sthesiol Intensivmed Notfallmed Schmerzther 1996; 31:362-367.
32. Aram L, Krane EJ, Kozloski LJ, Yaster M. Tunneled epidural catheters for prolonged analgesia in pediatric patients. Anesth Analg 2001; 92:1432- 1438.
33. Fujinaka W, Hinomoto N, Saeki S, et al. Decreased risk of catheter infection in infants and children using subcutaneous tunneling for continuous caudal anesthesia. Acta Med Okayama 2001; 55:283-287.
34. Vas L, Naik V, Patil B, Sanzgiri S. Tunnelling of caudal epidural catheters in infants. Paediatr Anaesth 2000; 10:149-154.
35. Bubeck J, Boos K, Krause H, Thies K. Subcutaneous Tunneling of Caudal Catheters Reduces the Rate of Bacterial Colonization to That of Lumbar Epidural Catheters. Anesthesia & Analgesia. 2004;99:689-693.
36. Kinirons B, Mimoz O, Lafendi L, et al. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial. Anaesthesiology 2001; 94:239-244.
37. BuÈttner W, Finke W. Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Paediatr Anaesth 2000; 10:303-318.
38. Lejus C, Surbled M, Schwoerer D, et al. Postoperative epidural analgesia with bupivacaine and fentanyl: hourly pain assessment in 348 paediatric cases. Paediatr Anaesth 2001; 11:327-332.
39 Joselyn A,Bhalla T, Schloss B, Martin D,Tobias J.A case report of a retained and knotted caudal epidural catheter.Saudi J Anaesth 2014;8:424.


How to Cite this Article: Ponde V, Puri K, Dave N | Continuous Caudal Catheters in Neonatal Population: A Focussed Review | International Journal of Regional Anaesthesia | July-December 2021; 2(2): 124-130.

 


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