Paediatric caudal anaesthesia

Caudal anaesthesia (CA) is epidural anaesthesia of the cauda equina roots in the sacral canal, accessed through the sacral hiatus. CA is a common paediatric regional technique that is quick to learn and easy to perform, with high success and low complication rates. CA provides high quality intraoperative and early postoperative analgesia for sub-umbilical surgery. In children, CA is most effectively used as adjunct to general anaesthesia and has an opioid-sparing effect, permitting faster and smoother emergence from anaesthesia. INDICATIONS FOR CAUDAL ANAESTHESIA The indications for single shot CA are abdominal, urologic or orthopaedic surgical procedures located in the sub-umbilical abdominal, pelvic and genital areas, or the lower limbs, where postoperative pain does not require prolonged strong analgesia. Examples of appropriate surgery include inguinal or umbilical herniorrhaphy, orchidopexy, hypospadias and club foot surgery. CA is useful for day case surgery, but opioid additives to the local anesthetic agent should be avoided in this setting. When CA is used, requirement for mild or intermediate systemic analgesia must be anticipated to prevent pain resurgence at the end of caudal block. Catheter insertion can extend the indications to include surgical procedures located in the high abdominal or thoracic areas, and to those requiring prolonged effective analgesia.