Neuraxial blockade in children

Epidural blockade in children has become more popular for postoperative analgesia in recent years owing to increased experience, greater confidence and the development of appropriate equipment. In the UK, approximately 2000 lumbar epidural and continuous caudal blocks are performed each year. Spinal anaesthesia remains popular for babies at risk of postoperative apnoea, but is being superseded by light general anaesthesia with desflurane or sevoflurane combined with caudal blockade. Contraindications to neuraxial blockade include patient or parental refusal, coagulation abnormalities, septicaemia, raised intracranial pressure, meningitis, infection at the entry site, allergy to local anaesthetics, myelomeningocele (spina bifida) and abnormal sacral anatomy for a caudal epidural.