Comparison of Caudal Epidural Block Using Ultrasound Guidance Versus the Conventional Technique in Adult Patients Undergoing Elective Perianal Surgery

Dr. Mahima Singh; Dr. Charu Bamba

Volume : VIII, Issue : I, January - 2019

Comparison of Caudal Epidural Block Using Ultrasound Guidance Versus the Conventional Technique in Adult Patients Undergoing Elective Perianal Surgery

Dr. Mahima Singh, Dr. Charu Bamba

Abstract :

Background: Ultrasonography has been instrumental in the resurgence of regional anesthesia. Its ability to locate and define the sacral hiatus is the key to success of caudal epidural anesthesia. Ultrasound is known to guide the placement of the needle with a potential at technique enhancement and improved patient�s acceptance in various nerve blocks . Various modalities, viz �POP�, �swoosh�, �woosh� and �LOR� exist for identifying the caudal epidural space. Their overall failure rate is about 41%. Use of imaging technology has been recommended to improve the success rate. Fluroscopy is the �Gold Standard� for caudal epidural blocks. Several studies have shown a success rate >95% when performed under ultrasound guidance. Objectives: To elucidate the role of ultrasound in improving the success rate in caudal epidural anesthesia and in improving overall patient comfort. Materials & Methods: ASA grade I & II patients between ages 18–65 years, BMI <25 kg/m2, undergoing elective perianal surgery, were selected and allocated, by randomized lottery, into Group �A� or �B�. Group �A� received the block under ultrasound guidance while group �B� received the conventional �loss of resistance� technique. 15.0ml of preservative free isobaric 0.5% Bupivacaine was administered for the block. Results: The success rate was 94% in group �A� vs 78% in group�B� (P=0.04). Mean time for procedure was 8.82�0.92 mins in group �A� vs 10.78�2.5 mins in group �B� (P<0.0005). Mean number of needle insertions were 1.38�0.6 in group �A� vs 1.92�0.78 in group �B� (P<0.0005). Mean number of needle redirections were 0.98�1.02 in group �A� vs 2.7�1.59 in group �B� (P<0.0005). The patient satisfaction score, on a scale of 1-5, was 4.24�0.87 in group �A� vs 3.42�0.86 in group �B� (P<0.0005). Conclusion: Ultrasound can be a useful tool to guide the placement of the epidural needle with a potential at technique enhancement, improve patients acceptance, minimizing failure rates and reducing radiation exposure in chronic pain deserving further investigation. However, the use of ultrasonography, in several cases, is user dependant.