New advances in technique for pediatric caudal and epidural placement

Epidural anesthesia can provide safe and effective analgesia in children; however, it is essential to give consideration to which epidural approach will be superior and which confirmation technique, if needed, will assist optimal catheter placement. Accurate segmental localization is important in pediatric epidurals, for avoiding local anesthetic toxicity and side effects through maximizing effect with minimal doses. Nerve stimulation and electrocardiography allow continuous and real-time monitoring of the position of the catheter tip. Electrical epidural stimulation may also help warn of intrathecal, subarachnoid or intravascular catheter or needle placement. Ultrasound guidance during central block procedures may be very advantageous in cases where clear visibility of anatomical structures and block-related equipment is possible. Ultrasound imaging can be of great help to determine the depth of the epidural space and estimate the best needle puncture site and angle. Methods to enhance the visibility of structures are introduced. Innovative techniques for use in pediatric neuraxial anesthesia will ultimately increase our confidence with the procedures and expand the utilization of regional anesthesia in children.