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Background and Aims This comparative study aimed to assess the efficacy and safety of ultrasound-guided caudal anesthesia versus blind caudal anesthesia for subumbilical surgery in pediatric patients.

Methods Pediatric patients undergoing subumbilical surgery were prospectively included and divided into two groups: ultrasound-guided caudal anesthesia and blind caudal anesthesia. Primary outcomes evaluated included block placement success rate, onset and duration of sensory and motor blockade, analgesic requirements, and perioperative complications.

Results The study included 40 patients, with 20 in each group. Ultrasound-guided caudal anesthesia showed a significantly higher success rate of block placement (p < 0.001), faster onset of sensory and motor blockade (p < 0.05), and longer duration of analgesia (p < 0.05) compared to blind caudal anesthesia. Postoperative analgesic requirements were significantly lower in the ultrasound-guided group (p < 0.001). There were no significant differences in perioperative complications between the two groups.

Conclusions Ultrasound-guided caudal anesthesia was superior to blind caudal anesthesia for subumbilical surgery in pediatric patients. It provided higher success rates, faster onset, longer duration of blockade, reduced analgesic requirements, and comparable safety. Ultrasound guidance should be preferred for caudal anesthesia in this patient population.