Decreasing the Invasiveness of Ultrasound Guided Caudal Block: A Comparison Between 22-gauge and 27-guage Needles

University of Jordan100 enrolled

Overview

Ultrasound (US) has facilitated the use of caudal block in children and visualization of the needle during insertion. This prospective clinical trial study compares between two different sizes of the used needles, in terms of success rate, number of punctures, detection of the US signs (visualization of the needle, dural displacement, turbulence, and distention), and complications in pediatrics aging between 6-36 months requiring elective lower abdominal and perineal surgeries.

Ultrasound (US) has facilitated the use of caudal block in children, allowing an initial assessment of the anatomy of the sacrum, including the relationship of the sacral hiatus to the dural sac ending. Real-time US allows visualization of the needle during insertion to reach the dural sac, and to see the turbulence and distention of the layers during injection of the local anesthetic drug. This prospective clinical trial study compares between two different sizes of the used needles, in terms of success rate, number of punctures, detection of the US signs (visualization of the needle, dural displacement, turbulence, and distention), and complications in pediatrics aging between 6-36 months requiring elective lower abdominal and perineal surgeries.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

100

Conditions

Anesthesia Pain

Interventions

The use of classical Gauge 22 needleDEVICE

After induction of general anesthesia, patients will undergo caudal block by using classical Gauge 22 needle under ultrasound guidance using a linear probe 5.5-12 MHz.

The use of classical Gauge 27 needleDEVICE

After induction of general anesthesia, patients will undergo caudal block by using Gauge 27 needle under ultrasound guidance using a linear probe 5.5-12 MHz.

Eligibility

Sex: ALLMin age: 6 MonthsMax age: 36 MonthsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 6 months and 36 months * Undergoing elective lower abdominal or perineal surgeries Exclusion Criteria: * Refusal of the legal guardian of the patient. * Patients aging less than 6 months, or older than 36 months. * Emergency surgeries. * Coagulopathy. * infection at the site of procedure. * Uncorrected hypovolemia. * Increased intracranial pressure. * Congenital anomalies at the site of procedure.

Outcomes

Primary Outcomes

Opioids requirements intraoperatively

The investigators will document the required dose of opioids intraoperatively

Time frame: 90 minutes

Pain score in the post-anesthesia care unit (PACU)

Pain score will be assessed regularly during the stay in the PACU using a pain scoring scale, where the score is interpreted from 0 to 10, in which 0 means no pain and 10 signifies very severe pain.

Time frame: 120 minutes

Peri-operative complications

Peri-operative complications related to the caudal block procedure will be documented from the start of the procedure till the discharge from the post-anesthesia care unit.

Time frame: 210 minutes