[Utility of epidural catheterization by the caudal route in pediatric anesthesia].

OBJECTIVES

To compare analgesic effect of bupivacaine during and after surgery when delivered through a lumbar epidural catheter entering by the caudal route with either caudal or lumbar administration of anesthetic through the needle.

PATIENTS AND METHODS

One hundred forty ASA I patients under 110 months undergoing infraumbilical surgery were studied. The children were distributed randomly into 3 groups: group 1, caudal puncture and anesthesia with 2.5 mg/kg bupivacaine 1:200,000; group 2, lumbar puncture at L4-L5 and 1.25 mg/kg of the same local anesthetic; and group 3, epidural catheter in the caudal space up to L4-L5 and 1.25 mg/kg of the same local anesthetic administered through the catheter (Minipack: SYSTEM 2-Portex). The patients were anesthetized with endovenous or inhalational anesthetics. Variables recorded were analgesia during surgery (hemodynamic constants) and afterwards (CHEOPS scale), level of cutaneous sensory blockade immediately after the operation and its relationship to age, complementary analgesia used and complications. X-rays of the distal end of the catheter were taken in group 3.

RESULTS

Analgesia during and after surgery was sufficient for all patients in group 1. Two patients, 1 from group 2 and 1 from group 3, were eliminated due to lack of analgesia during surgery. The level of cutaneous sensory blockade attained was significantly lower in group 3 than in group 1, and only in group 1 were we able to establish a linear correlation between level of sensory blockade and age (R = 0.51; p < 0.01). In group 3, 85.5% of the catheters reached L4-L5. Complementary analgesia was similar in the three groups. Complications included 5 cases of blood loss at the point of puncture in groups 1 and 2, and 1 case of catheter penetration of the juncture in group 3.

CONCLUSIONS

Epidural anesthesia by way of a catheter entering by the caudal space allows us to achieve intra- and postoperative analgesia of comparable quality to that afforded by a lumbar approach or a single direct caudal puncture.