Most effective for children <20 Kg (~ under 6 years of age) and for dermatomes below T10
Common side effects are weakness of legs, urinary retention etc
Because of this, sometimes a caudal block may necessitate overnight admission
The incidence of epidural hematoma has been reported as 1 in 80000 cases
Dose calculation can be done using Armitage ( 0.5 mL/kg for lumbosacral & 1 mL/kg for lumbar blockade, with 0.25% levobupivacaine ) or Scott formulas
Additives used in caudal block:
Preservative free Ketamine: Extend duration of analgesia; not used in infants <6 months of age due to fear of neurotoxicity
Clonidine : Extend duration of analgesia; not used in preterm infants and neonates due to higher incidence of bradycardia and apnoea. Provides postoperative sedation also.
Opioids when used as additives produce side effects like respiratory depression, pruritus & PONV
#EpiduralBlock , #Anaesthesia , #Anesthesia
References: De Beer DAH, Thomas ML. Caudal additives in children: solutions or problems? Br J Anaesth. 2003; 90: 487–498. Patel D. Epidural analgesia for children. Contin Educ Anaesth Crit Care Pain. 2006; 6(2): 63–66.