Year : 2015  |  Volume : 9  |  Issue : 2  |  Page : 128-131

Caudal epidural blockade for major orthopedic hip surgery in adolescents

1 Department of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio, United States
2 The Ohio State University College of Medicine, Columbus, Ohio, United States
3 Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States

Correspondence Address:
Dr. Brian Schloss
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205
United States
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1658-354X.152832

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Background: There continues to be a significant focus on the value of regional and neuraxial anesthesia techniques for adjunctive use when combined with general anesthesia. The reported advantages include decreased patient opiate exposure, decreased medication-related adverse effects, decreased postanesthesia recovery room time and hospital stay, and increased patient satisfaction. Materials and Methods: The authors present a case-controlled series evaluating the use of a single caudal epidural injection prior to incision as an adjunct to general anesthesia for the open repair of slipped capital femoral epiphysis. Opiate consumption, pain scores, and hospital stay were compared between the two cohorts of 16 adolescent patients. All patients received a demand-only patient-controlled opiate delivery system. Results: Although the failed block rate was high (31%), there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block. Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block. Conclusion: The potential utility of caudal epidural block as an adjunct to general anesthesia during major hip surgery in adolescents is presented. Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.

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