Ultrasound-guided versus conventional injection for caudal block in children: A prospective randomized clinical study

Study objective: The aim of this study was to compare the efficacies of ultrasound guided sacral hiatus injection and conventional sacral canal injection performed for caudal block in children. Design: Randomized controlled clinical trial. Setting: Operating rooms of university hospital of Erzurum, Turkey. Patients: One hundred-thirty four children, American Society of Anesthesiologists I-II, between the ages of 5 and 12, scheduled for elective phimosis and circumcision surgery. Interventions: Patients assigned to two groups for ultrasound guided caudal block (Group U, n = 68) or conventional caudal block (Group C, n = 66). Caudal solution was prepared as 0.125% levobupivacaine plus 10 mcg/kg morphine (total volume: 0.5 ml/kg), and was administered to both groups. Measurements: The block performing time, the block success rate, the number of needle puncture, the success at first puncture and the complications were recorded. Main results: The block performing time and the success rate of block were similar between Group U and Group C (109.96 +/- 49.73 s vs 103.17 +/- 45.12 s, and 97% vs 93%, respectively p > 0.05). The first puncture success rate was higher in Group U than in Group C (80% vs 63%, respectively p = 0.026). No significant difference was observed between the groups with regard to the number of needle punctures (p = 0.060). The rates of vascular puncture and subcutaneus bulging were higher in Group C than in Group U (8/66 vs 1/68, and 8/66 vs 0/68, respectively p < 0.05). Conclusions: Despite the limitations in central neuroaxial anesthesia we recommend the use of ultrasound since it reduces the complications and increases the success rate of first puncture in pediatric caudal injection.