Ultrasound assessment of cranial spread during caudal blockade in children: effect of the speed of injection of local anaesthetics

Br J Anaesth. 2012 Apr;108(4):670-4. doi: 10.1093/bja/aer502. Epub 2012 Feb 6.


Background: Despite caudal blockade being the most widely used regional anaesthetic procedure for infants and children undergoing subumbilical surgery, the question whether the injection velocity of the local anaesthetic itself affects its spread in the epidural space has not yet been investigated. Thus, the aim of the present study was to measure the cranial spread of caudally administered local anaesthetics in infants and children by means of real-time ultrasonography, with a special focus on comparing the effect of using two different speeds of injection.

Methods: Fifty ASA I-II infants and children, aged up to 6 yr, weighing up to 25 kg, undergoing subumbilical surgery, were enrolled in this prospective, randomized, observer-blinded study. Caudal blockade was performed under ultrasound observation using ropivacaine 1 ml kg(-1) 0.2% or 0.35% and an injection given at either 0.25 ml s(-1) or 0.5 ml s(-1), respectively.

Results: Ultrasound observation of the local anaesthetic flow and the extent of cranial spread was possible in all patients. All caudal blocks were considered successful, and all surgical procedures could be completed without any indications of insufficient analgesia. No statistically significant difference could be observed between the two injection speeds regarding the cranial spread of the local anaesthetic in the epidural space.

Conclusions: The main finding of the present study is that the speed of injection of the local anaesthetic does not affect its cranial spread during caudal blockade in infants and children. Therefore, the prediction of the cranial spread of the local anaesthetic, depending on the injection speed, is not possible.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Amides / administration & dosage
  • Amides / pharmacokinetics*
  • Anesthesia, Caudal / methods*
  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / pharmacokinetics*
  • Child
  • Child, Preschool
  • Cortical Spreading Depression / drug effects
  • Drug Administration Schedule
  • Dura Mater / diagnostic imaging*
  • Epidural Space / diagnostic imaging
  • Female
  • Humans
  • Infant
  • Injections
  • Male
  • Prospective Studies
  • Ropivacaine
  • Single-Blind Method
  • Spinal Canal / diagnostic imaging
  • Time Factors
  • Ultrasonography, Interventional / methods*


  • Amides
  • Anesthetics, Local
  • Ropivacaine