Infrared Thermography for Assessment of Caudal Block in Children

Ann & Robert H Lurie Children's Hospital of Chicago14 enrolled

Overview

Regional analgesia via caudal neuraxial blockade provides pain relief for pediatric patients following urological and lower extremity procedures. The injection of local anesthetic into the caudal epidural space causes a sensory loss. This sympathetic blockade in turn causes a vasodilation, or increased blood flow, to the lower extremities. The purpose of this study is to determine whether the FLIR ONE thermographic camera, a smartphone attachment which utilizes an application ("app") to measure the temperature at a site on an image of the lower extremity, will be able to differentiate between caudal, non-caudal, and failed caudal images.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

SCREENING

Masking

NONE

Enrollment

Conditions

Anesthesia, Conduction

Interventions

Eligibility

Sex: ALLMin age: 6 MonthsMax age: 5 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Children from 6mos to 5 years of age requiring general anesthesia and a caudal block for a surgical procedure Exclusion Criteria: * Patients with preexisting conditions that could affect the skin temperature on the lower extremities such as infection, edema, vascular disorder, etc. * American Society of Anesthesiologists comorbidity ranking of 4 or greater * Patient with contraindications for a caudal block such as: history of allergic, reactions to local anesthetics, coagulopathy, infection at the injection site, spinal abnormality, peripheral neurological disease, Raynaud's disease

Outcomes

Primary Outcomes

Predictive value of FLIR ONE

Reviewers blinded to intervention groups will asses patient pre-caudal, 1, 2, 3, 4, and 5 minute post-caudal images and rate whether, based on the image, they believe the patient received a caudal or not. The sensitivity and specificity of the FLIR ONE as a diagnositic tol will then be determined.

Time frame: Assessments will be done through study completion, an average of 1 week following procedure.

Secondary Outcomes

Inter- and Intra- rater reliability

Reviewers will evaluate patient image at two separate ties at least a week apart. Recorded images will be compared within and between reviewers.

Time frame: Assessments will be done through study completion, an average of 1 week following procedure.

Temperature differences between pre-caudal and 5 minute post-caudal images

Temperature differences between pre-caudal and 5 minute images will be summarized in both groups. Images in the non-caudal group will be taken at similar time points following anesthesia induction relative to caudal group patients.

Time frame: Images will be captured prior to caudal and 5 minutes immediately afterwards. Assessments will be done through study completion, an average of 1 week following procedure.