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Poster displayed – Paediatrics
P220 Real-time ultrasound-guided caudal epidural blockade for perioperative analgesia in a neonate: images in anesthesiology
  1. Carolina Madruga1,
  2. Acácia Silva2,
  3. Gabriela Costa3,
  4. Maria Inês Taborda1 and
  5. Teresa Cenicante3
  1. 1Anesthesiology Department, Unidade Local de Saúde Amadora/Sintra, Amadora, Portugal, Amadora, Portugal
  2. 2Anesthesiology Department, Unidade Local de Saúde do Tâmega e Sousa, Penafiel, Portugal, Penafiel, Portugal
  3. 3Pediatric Anesthesiology Department, Unidade Local de Saúde São José – Hospital Dona Estefânia, Lisbon, Portugal, Lisbon, Portugal

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Regional anesthesia has gained increasing importance in pediatric surgery due to its efficacy in providing perioperative pain relief with fewer systemic effects. Caudal epidural anesthesia is a safe and effective technique, reducing intraoperative anesthetic requirements and postoperative respiratory depression, especially in vulnerable neonates. Ultrasound can improve its performance by aiding in identifying anatomical variations, localizing the dural sac, and reducing the incidence of complications.

Methods We present a case of a two-day-old neonate undergoing surgical correction of jejunal atresia under combined general-epidural anesthesia. We conducted a rapid sequence induction with fentanyl, propofol and rocuronium and we used videolaryngoscopy for intubation. Afterwards, the patient was positioned in lateral decubitus with hips and knees flexed. After a failed hematic puncture through anatomical references, ultrasound-guided single-shot caudal epidural blockade was performed, using a linear transducer, with injection of 1.25mL/kg (Armitage formula) of ropivacaine 0.2% to achieve a thoracic epidural block level. The procedure was successful, with precise needle placement and adequate local anesthetic spread observed under real-time ultrasonography.

Results Effective perioperative pain relief was achieved, with stable hemodynamics observed throughout the procedure. Postoperatively, the neonate was transferred to the neonatal intensive care unit and extubated 11 hours later.

Conclusions Ultrasound-guided caudal epidural blockade is a safe and effective method for perioperative pain relief in neonates, often enabling earlier extubation. Pediatric anesthesiologists should be proficient in sonographic neuraxial and dural sac anatomy, particularly in neonates, to safely perform this block, especially in cases of aberrant anatomy or to mitigate potential technique-related complications.

Abstract P220 Figure 1
Abstract P220 Figure 1

Ultrasound view of the transverse plane

Abstract P220 Figure 2
Abstract P220 Figure 2

Ultrasound view of the longitudinal plane (needle placement)

Abstract P220 Figure 3
Abstract P220 Figure 3

Ultrasound view of the longitudinal plane (injection of local anesthetic)

  • caudal epidural
  • ultrasound
  • neonates
  • analgesia
  • respiratory depression

https://doi.org/10.1136/rapm-2024-ESRA.396

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