Caudal epidural block is a commonly performed procedure in pediatric age group. It offers excellent analgesia without the side effects of intravenous opioid medications, viz. nausea, sedation, and respiratory depression. Caudal blocks are generally performed after induction of general anesthesia in children. Traditional teaching relies on the subjective sensation of “give” or “pop” felt by the operator as the advancing needle pierces the sacrococcygeal ligament and the lack of resistance to injection of the local anesthetic. Although the block is easily performed, the success rate is less than 100% and varies with the experience of the operator. Objective parameters of successful caudal needle placement will increase the success of the block. In a large teaching hospital such as ours, with a number of residents in training, additional methods to predict correct needle placement would increase accuracy. Several studies have evaluated the accuracy of parameters to predict correct caudal needle placement. These include an audible “swoosh” on auscultation over the lower back during injection, a reduction in heart rate during drug injection and a lax anal sphincter at the end of the procedure. This study was undertaken to compare the sensitivity, specificity, positive predictive value, and negative predictive value of the following predictors of successful caudal block, viz. swoosh test, heart rate reduction during injection, and laxity of anal sphincter following procedure |
