Nerve Block Procedure Safe for Children

Caudal nerve block in children has a low complication rate, with little or no risk of long-term adverse effects, according to a new study.

Researchers at Northwestern University (Chicago, IL, USA) conducted an observational study involving 18,650 children to estimate the overall and specific incidence of complications associated with the performance of caudal block; the data were retrieved from the pediatric regional anesthesia network (PRAN) database. A complication was defined by the presence of block failure, vascular puncture, intravascular test dose, dural puncture, seizure, cardiac arrest, sacral pain, or neurologic symptoms. In addition, the presence of temporary or permanent sequela was evaluated.

The procedures were performed at 18 children's hospitals from 2007 to 2012, with average patient age being 14 months. The complication rate was 1.9%, with the most common complications being block failure, blood aspiration, and intravascular injection, but none of the reported complications led to lasting or permanent adverse effects. Serious complications such as cardiac arrest and seizure were rare, occurring in just four children. The study was published in the October 2014 issue of Anesthesia & Analgesia.

“The results draw attention to variations in the local anesthetic doses used for caudal block, potentially increasing the risk of toxic effects,” warned lead author Santhanam Suresh, MD, and colleagues. “Further studies are needed to define the optimal local anesthetic dosage, as well as the pain-relieving effectiveness of caudal block for specific types of surgery.”

“The PRAN database was a lot of work to create, but it is an important contribution to the safety of children undergoing anesthesia,” commented Steven Shafer, MD, of Stanford University (CA, USA), editor-in-chief of Anesthesia & Analgesia. “This paper shows that caudal blocks for postoperative pain control are safe in children. It will help to guide physicians, and parents, in selecting the anesthetic that provides the best outcome for their kids.”

The caudal block is the most commonly performed regional anesthesia technique in pediatric patients undergoing surgical procedures, involving a small dose of local anesthetic injected into the base of the spine to numb feeling in the lower body. It is usually added to general anesthesia, with the aim of controlling pain after surgery while reducing the required dose of general anesthetic.

Related Links:
Northwestern University