Confirmation of Caudal Needle Placement Using Nerve Stimulation 

1999 ◽  
Vol 91 (2) ◽  
pp. 374-378 ◽  
Author(s):  
Ban C. H. Tsui ◽  
Pekka Tarkkila ◽  
Sunil Gupta ◽  
Ramona Kearney
Keyword(s):  
Local Anesthetic ◽  
Nerve Stimulation ◽  
Pediatric Patients ◽  
Needle Insertion ◽  
Stimulation Test ◽  
Needle Placement ◽  
Caudal Block ◽  
Stimulation Tests ◽  
Local Anesthetic Injection ◽  
To Receive

Background The study was designed to examine a new method of confirming proper caudal needle placement using nerve stimulation. Methods Thirty-two pediatric patients were studied. A 22-gauge insulated needle was inserted into the caudal canal via the sacral notch until a "pop" was felt. The needle placement was classified as correct or incorrect depending upon the presence or absence of anal sphincter contraction (S2-S4) to electrical simulation (1 to 10 mA). Results Three patients were excluded, two because they inadvertently received neuromuscular blockers and one because the patient's anatomy precluded any attempt at a caudal block. The sensitivity and specificity of the test were both 100% in predicting clinical outcomes of the caudal block. Six patients had a negative stimulation test after the first attempt to place the needle. Four of these went on to receive a second attempt of needle insertion after a subcutaneous bulge or resistance to local anesthetic injection were observed. Following needle reinsertion, positive stimulation tests were elicited. These patients received the local anesthetic injection with ease and had good analgesia postoperatively. No attempt was made to reinsert the needle in the remaining two patients with a negative stimulation test, as they did not show subcutaneous bulge or resistance upon injection. These patients had poor analgesia postoperatively. The positive predictive value of the test was greater than the presence of a "pop" alone (P < 0.05) but not significantly different (P = 0.492) over the presence of "pop" and easy injection. Conclusion This test may be used as a teaching and adjuvant tool in performing caudal block.

Pain Perception: Computerized versus Traditional Local Anesthesia in Pediatric Patients

2015 ◽  
Vol 39 (5) ◽  
pp. 470-474 ◽  
Author(s):  
M Mittal ◽  
A Kumar ◽  
D Srivastava ◽  
P Sharma ◽  
S Sharma
Keyword(s):  
Heart Rate ◽  
Local Anesthesia ◽  
Study Design ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Pediatric Patients ◽  
Computerized Method ◽  
Local Anesthetic Injection ◽  
Computerized System ◽  
Buccal Infiltration

Background: Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. Study design: The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. Study design: It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Results: Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. Conclusion: It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups

scholarly journals Ultrasound assessed a new method of needle insertion at an angle of 90°to the apex of the sacral hiatus for caudal block in newborns: a randomized controlled study

2019 ◽  
Author(s):  
Shangyingying Li ◽  
Yanzhe Tan ◽  
Fei Yang ◽  
Lifei Liu ◽  
Shengfen Tu
Keyword(s):  
Failure Rate ◽  
Conventional Method ◽  
Local Anesthetic ◽  
Needle Insertion ◽  
New Method ◽  
Controlled Study ◽  
Minimal Risk ◽  
Caudal Block ◽  
Sacral Hiatus ◽  
Method Group

Abstract Background Caudal block is widely used in paediatric anaesthetic practice. Many angles for needle insertion were compared to find a optimal angle during caudal block with high successful caudal injection and minimal risk of complications. The aim of this study is to evaluate the safety and effectivity of a new method of needle insertion at an angel of 90°to the apex of the sacral hiatus for caudal block in newborns. Methods Sixty patients were included in our study, aged 0 to 28 days, posted for inguinal hernia surgery, randomly divided into two groups: a conventional method (CM) group and a new method (NM) group. In both groups, 1 ml∙kg-1 0.5% lignocaine at a rate of approximately 0.5 ml∙s-1 was given for caudal blocks after anaesthesia, and ultrasonographic observation of local anesthetic in the epidural space. Failure rate at the first attempt, puncture frequency, complications, and durations of block were recorded. Results The failure rate at the first attempt of caudal block were 16.7% in the conventional method group and 3.3% in the new method group (p<0.05). The mean time required (standard deviation) to perform needle insertion in the conventional method group was 2.6±0.5 minutes and in new method group 1.6±0.5 minutes (p<0.05). There were three cases aspirating the needle to find blood and one case to find cerebrospinal fluid in the conventional method group. The majority level which the local anesthetic reached are L1 by ultrasound imaging, 86.7% in the conventional method group and 83.3% in the new method group. Conclusion The study found that using the new method, the chance of performing a successful caudal injection can be increased, the time and the risk can be minimized compared to conventional technique. It is a safe and effective method.

A Novel Introducer for Ultrasound-Guided Cryoneurolysis Administration to Improve Patient Safety an d Functionality

2020 ◽  
pp. 217-220
Author(s):  
JOhn J. Finneran IV
Keyword(s):  
Peripheral Nerve ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Improve Patient Safety ◽  
Femoral Nerve ◽  
Needle Insertion ◽  
Ultrasound Guided ◽  
Needle Pass ◽  
Time Required ◽  
Local Anesthetic Injection

Background: Percutaneous cryoneurolysis provides prolonged postoperative analgesia by placing a probe adjacent to a peripheral nerve and cooling the probe tip, inducing a reversible block that lasts weeks to months. Unfortunately, freezing the nerve can produce significant pain. Consequently, local anesthetic is generally applied to the nerve prior to cryoneurolysis, which, until now, required an additional needle insertion increasing both the risks and duration of the procedure. Case Presentation: Three patients underwent ultrasound-guided percutaneous cryoneurolysis of either the sciatic and saphenous nerves or the femoral nerve. In all patients, the local anesthetic injection and cryoneurolysis were accomplished with a single needle pass using the novel probe introducer. Conclusion: This introducer allows perineural local anesthetic injection followed immediately by cryoneurolysis, thereby sparing patients a second skin puncture, lowering the risks of the procedure, and decreasing the overall time required for cryoneurolysis. Key words: Cryoablation, cryoanalgesia, peripheral nerve block, postoperative analgesia, ultrasound

An Additional Sign of Correct Needle Placement When Performing a Caudal Block in Pediatric Patients

1994 ◽  
Vol 79 (4) ◽  
pp. 818 ◽  
Author(s):  
Roy E. Schwartz ◽  
Stephen A. Stayer ◽  
Caroline A. Pasquariello
Keyword(s):  
Pediatric Patients ◽  
Needle Placement ◽  
Caudal Block ◽  
Additional Sign

Anatomical basis of fascial plane blocks

2021 ◽  
Vol 46 (7) ◽  
pp. 581-599
Author(s):  
Ki Jinn Chin ◽  
Barbara Versyck ◽  
Hesham Elsharkawy ◽  
Maria Fernanda Rojas Gomez ◽  
Xavier Sala-Blanch ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Clinical Utility ◽  
Needle Insertion ◽  
Ultrasound Guided ◽  
Internal Organs ◽  
Paravertebral Space ◽  
Anatomical Basis ◽  
Local Anesthetic Injection ◽  
Visceral Innervation ◽  
Fascial Plane

Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space (“plane”) between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatomical concepts relevant to FPBs, with a focus on blocks of the torso. Fascia, in this context, refers to any sheet of connective tissue that encloses or separates muscles and internal organs. The basic composition of fascia is a latticework of collagen fibers filled with a hydrated glycosaminoglycan matrix and infiltrated by adipocytes and fibroblasts; fluid can cross this by diffusion but not bulk flow. The plane between fascial layers is filled with a similar fat-glycosaminoglycan matric and provides gliding and cushioning between structures, as well as a pathway for nerves and vessels. The planes between the various muscle layers of the thorax, abdomen, and paraspinal area close to the thoracic paravertebral space and vertebral canal, are popular targets for ultrasound-guided local anesthetic injection. The pertinent musculofascial anatomy of these regions, together with the nerves involved in somatic and visceral innervation, are summarized. This knowledge will aid not only sonographic identification of landmarks and block performance, but also understanding of the potential pathways and barriers for spread of local anesthetic. It is also critical as the basis for further exploration and refinement of FPBs, with an emphasis on improving their clinical utility, efficacy, and safety.

The use of a nerve stimulation test to confirm sacrococcygeal epidural needle placement in cats

2015 ◽  
Vol 42 (1) ◽  
pp. 115-118 ◽  
Author(s):  
Pablo E Otero ◽  
Natali Verdier ◽  
Andrea S Zaccagnini ◽  
Santiago E Fuensalida ◽  
Lisa Tarragona ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Stimulation Test ◽  
Epidural Needle ◽  
Needle Placement

scholarly journals Guidance of Block Needle Insertion by Electrical Nerve Stimulation

2008 ◽  
Vol 109 (3) ◽  
pp. 473-478 ◽  
Author(s):  
Marcel Rigaud ◽  
Patrick Filip ◽  
Philipp Lirk ◽  
Andreas Fuchs ◽  
Geza Gemes ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Stimulation ◽  
Needle Insertion ◽  
High Threshold ◽  
High Current ◽  
Needle Placement ◽  
Current Group ◽  
Electrical Nerve Stimulation ◽  
Low Threshold ◽  
Intraneural Injection

Background Little is known regarding the final needle tip location when various intensities of nerve stimulation are used to guide block needle insertion. Therefore, in control and hyperglycemic dogs, the authors examined whether lower-intensity stimulation results in injection closer to the sciatic nerve than higher-threshold stimulation. Methods During anesthesia, the sciatic nerve was approached with an insulated nerve block needle emitting either 1 mA (high-current group, n = 9) or 0.5 mA (low-current group, n = 9 in control dogs and n = 6 in hyperglycemic dogs). After positioning to obtain a distal motor response, the lowest current producing a response was identified, and ink (0.5 ml) was injected. Frozen sections of the tissue revealed whether the ink was in contact with the epineurium of the nerve, distant to it, or within it. Results In control dogs, the patterns of distribution using high-threshold (final current 0.99 +/- 0.03 mA, mean +/- SD) and low-threshold (final current 0.33 +/- 0.08 mA) stimulation equally showed ink that was in contact with the epineurium or distant to it. One needle placement in the high-threshold group resulted in intraneural injection. In hyperglycemic dogs, all needle insertions used a low-threshold technique (n = 6, final threshold 0.35 +/- 0.08 mA), and all resulted in intraneural injections. Conclusions In normal dogs, current stimulation levels in the range of 0.33-1.0 mA result in needle placement comparably close to the sciatic nerve but do not correlate with distance from the target nerve. In this experimental design, low-threshold electrical stimulation does not offer satisfactory protection against intraneural injection in the presence of hyperglycemia.

scholarly journals Inferior Alveolar Nerve Block Injection Pain Using a Computer-Controlled Local Anesthetic Device (CCLAD): A Prospective, Randomized Study

2018 ◽  
Vol 65 (4) ◽  
pp. 231-236
Author(s):  
Sara Fowler ◽  
Chase Crowley ◽  
Melissa Drum ◽  
Al Reader ◽  
John Nusstein ◽  
...  
Keyword(s):  
Nerve Block ◽  
Local Anesthetic ◽  
Supine Position ◽  
Inferior Alveolar Nerve ◽  
Needle Insertion ◽  
Injection Pain ◽  
Inferior Alveolar Nerve Block ◽  
Needle Placement ◽  
Solution Deposition ◽  
Computer Controlled

There is evidence that the Computer-Controlled Local Anesthetic Device (CCLAD) decreases the pain of oral injections. The purpose of this study was to evaluate injection pain of the inferior alveolar nerve block (IANB) using the CCLAD in an upright position versus a supine position. Additionally, we evaluated solution deposition pain with the CCLAD when compared to previous studies using a traditional syringe. One hundred ten asymptomatic subjects were randomly given IANBs using 2% lidocaine with 1:100,000 epinephrine while in an upright sitting position and supine position, at 2 different appointments, spaced at least 2 weeks apart. Each subject rated the pain for needle insertion, needle placement, and solution deposition on a Heft-Parker visual analogue scale. Pain ratings were compared between the upright and supine positions using a repeated-measures analysis of variance with post hoc testing using the Tukey-Kramer procedure. Moderate to severe pain was reported by 10% to 13% of the patients for needle insertion, 74% to 75% for full needle placement, and 8% to 10% for solution deposition. There was no significant difference between groups for phases of the injection. When comparing the injection phases within the groups, the needle placement phase of the injection was statistically more painful than both the needle insertion phase and solution deposition phase (p = .0001). Using the CCLAD, IANB injection pain of the supine and upright positions was not statistically different. Needle placement was the most painful phase of the injection. Solution deposition pain was less with the CCLAD when compared to other studies of the IANB using a traditional syringe.

Efficacy and safety of caudal dexmedetomidine in pediatric infra-umbilical surgery: a meta-analysis and trial-sequential analysis of randomized controlled trials

2021 ◽  
pp. rapm-2020-102024
Author(s):  
Ushma Jitendra Shah ◽  
Derek Nguyen ◽  
Niveditha Karuppiaah ◽  
Janet Martin ◽  
Herman Sehmbi
Keyword(s):  
Local Anesthetic ◽  
Local Anesthetics ◽  
Sequential Analysis ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Trial Sequential Analysis ◽  
Caudal Block ◽  
Moderate Evidence ◽  
Randomized Controlled

BackgroundDexmedetomidine is used as a local-anesthetics adjuvant in caudal block to prolong analgesia in pediatric infra-umbilical surgery.ObjectiveWe evaluated the analgesic efficacy and safety of the addition of caudal dexmedetomidine to local anesthetics (vs local anesthetics alone) in pediatric infra-umbilical surgery.Evidence reviewWe searched 10 databases for randomized controlled trials (RCTs) of pediatric patients undergoing infra-umbilical surgery, comparing caudal block with and without dexmedetomidine as local anesthetic adjuvant. We performed a frequentist random-effects meta-analysis (R statistical package). We analyzed continuous outcomes as a ratio of means (ROM) and dichotomous data as relative risk (RR), along with 95% CI. We included 19 RCTs (n=1190 pediatric patients) in the meta-analysis. The primary outcome was duration of analgesia (defined as ‘the time from caudal injection to the time at which the study-specific pain score was greater than a cut-off threshold’).FindingsData from 19 included RCTs (n=1190) suggested that compared with control (mean duration 346 min), the addition of caudal dexmedetomidine significantly prolonged the duration of analgesia (ratio of means 2.14, 95% CI 1.83 to 2.49, p<0.001; ‘moderate’ evidence). Trial-sequential analysis showed adequate ‘information size’ for the primary outcome. Caudal dexmedetomidine also reduced the number of analgesic administrations (‘low’ evidence), total acetaminophen dose (‘moderate’ evidence) and the risk of emergence delirium (‘moderate’ evidence). There were no significant differences in adverse effects such as hypotension, bradycardia, post-operative nausea and vomiting, urinary retention and respiratory depression.ConclusionsOur results suggest that the addition of dexmedetomidine to local anesthetic in caudal block significantly improves the duration of analgesia and reduces the analgesic requirements, while maintaining a similar risk-profile compared with local anesthetic alone. Further data on neurological safety are needed.

scholarly journals Caudal block with 3 mg/Kg Bupivacaine for intraabdominal surgery in pediatric patients: a randomized study

2011 ◽  
Vol 5 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Witthaya Loetwiriyakul ◽  
Thanyamon Asampinwat ◽  
Panthila Rujirojindakul ◽  
Mayuree Vasinanukorn ◽  
Tee Chularojmontri ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Pediatric Patients ◽  
Randomized Study ◽  
Volatile Anesthetic ◽  
Caudal Block ◽  
Adequate Dose ◽  
Group A ◽  
Group B ◽  
Double Blinded ◽  
To Receive

Abstract Background: Caudal block with the use of an adequate dose of bupivacaine, and combined with a general anesthesia (GA) provides intra-operative anesthesia and postoperative analgesia. No study has examined the use of 3 mg/Kg bupivacaine for intra-abdominal surgery in pediatric patients in clinical practice. Objective: Compare the effectiveness of three mg/Kg bupivacaine administered as 1.2 mL/Kg 0.25% bupivacaine and 1.5 mL/Kg 0.2% bupivacaine for caudal block in pediatric patients undergoing intra-abdominal surgery. Methods: In a randomized, double-blinded clinical trial, patients (age: 6 months -7 years) were randomly assigned into one of two groups (n= 40) to receive a caudal block with either 1.2 mL/Kg 0.25% bupivacaine (group A) or 1.5 mL/Kg 0.2% bupivacaine (group B), with morphine 50 μg/Kg. The effectiveness of intra-operative anesthesia, complications, and requirements for post-operative analgesia were evaluated. Results: Data were available for 74 pediatric patients. There were no significant differences between the two groups in baseline characteristics. Intra-operatively, the numbers of patients who required a rescue analgesic were comparable between the groups (67% in group A and 63% in group B). The numbers of patients who required a muscle relaxant were also comparable between groups (49% in group A and 57% in group B). The time from discontinuation of the volatile anesthetic to extubation was significantly shorter in group B (9.5±1.1 minutes) than group A (14.3±0.9 minutes), p < 0.01. The time from initial caudal block to the first analgesic required in the recovery room was significantly longer in group B (202±45 minutes) than in group A (149±27 minutes). The time from the caudal block to the first analgesic required in the ward was significantly longer in group B (10.4±3.1 hours) than in group A (8.2±2.0 hours). Overall fentanyl requirements were comparable between groups, 52.5±2.0 μg in group A and 49.5±3.0 μg in group B. Conclusion: Caudal block by either 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg or 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided effectively equivalent intra-operative analgesia and surgical relaxation. However, a caudal block with 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided superior prolonged analgesic advantages compared with 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg in pediatric patients undergoing intra-abdominal surgery.

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