Background and aims Caudal epidural block is a well-known method for anaesthesia and analgesia in children.¹ Ultrasound-guidance has been proven to enhance the success rate of this technique and may be of special value in the presence of spinal anomalies.^{1 2} We report a clinical case of an ultrasound-guided caudal epidural block for postoperative analgesia in a newborn with multiple vertebral malformations.

Methods A 1-day-old, 3120 g, full term newborn, ASA III, diagnosed with an anorectal atresia and several vertebral anomalies (thoraco-lumbar hemivertebrae, sacrococcygeal malformation and absence of S4-5 vertebra) was proposed for a derivative colostomy under combined anaesthesia. After induction of general anaesthesia and tracheal intubation, an ultrasound scan of the sacrococcygeal membrane and the epidural space was obtained to ascertain the feasibility of a continuous caudal block. Following the insertion of a 20G Tuohy needle in the sacrococcygeal membrane through an out-of-plane approach, a 22G epidural catheter was advanced till T11-12 level under in-plane visualization. An initial 1 ml bolus of ropivacaine 0,2% was administered before skin incision, followed by a ropivacaine 0,05% perfusion at 1,2 ml/h for 24 hours. Acetaminophen was the only other analgesic used intra- and postoperatively. The perioperative period was uneventful and rescue analgesic therapy was never necessary.

Results Ultrasound-guided continuous caudal block was performed successfully in a newborn with multiple vertebral anomalies and no technique-associated complications were recorded.

Conclusions Ultrasound-guided regional anaesthesia allows a safer and probably more successful performance of caudal blocks in this per se challenging paediatric subgroup.

References

1. Br J Anaesth 2019. doi: 10.1016/j.bja.2018.11.030

2. Eur J Pediatr Surg 2018. doi: 10.1055/s-0038-1676980