Search

BACKGROUND: Many studies indicate the effectiveness of intravenous lidocaine infusion for perioperative analgesia and treatment of intestinal paresis in adults. In the scientific literature, only a few publications focus on the intravenous infusion of lidocaine in pediatric practice. The purpose of the work is to increase the effectiveness of the treatment of pain syndrome after operations on abdominal organs in children by creating a protocol for intravenous lidocaine infusion. MATERIALS AND METHODS: In the development of the clinical protocol, publications included in the databases PubMed, Cochrane, American Society of Anesthesiologists, World Federation of Pediatric Intensive and Critical Care Societies, and American Academy of Pediatrics were considered. The recommendations and standards of care for this problem from the Committee on Pediatric Anesthesiology (Statement on Practice Recommendations for Pediatric Anesthesia, 2016), Society for Paediatric Anesthesia Anaesthesiology, and our own materials for our research performed at the St. Petersburg State Pediatric Medical University. RESULTS: The developed protocol includes 11 provisions, including indications and contraindications to the use of lidocaine infusion, preoperative examination, a list of necessary equipment, the method of infusion, methods of evaluation, and control of postoperative pain syndrome. CONCLUSIONS: A protocol for the management of children in the early postoperative period using intravenous lidocaine infusion, as an alternative to prolonged epidural blockade and systemic anesthesia, is developed. The authors express confidence that further implementation of the protocol in clinical practice will improve the quality of medical care for children after abdominal surgical interventions.

Background. The anesthetic technique of choice for urological surgeries is a controversial issue, especially for transvesical prostatectomy for patients with benign prostatic hyperplasia (BPH). Often, epidural anesthesia and analgesia are considered as the methods of choice. However, the effect of an anesthetic support on perioperative changes in hemostatic potential has been poorly studied. Aim. The aim of the study was to demonstrate the dynamics of changes in the system of the aggregate blood state regulation by using an instrumental method, a low-frequency piezoelectric thromboelastography (LFPTEG), in the perioperative period for patients with BPH who will undergo transvesical prostatectomy. Material and methods. The state of the hemostatic system in a group of 71 patients with confirmed BPH who required a transvesical prostatectomy was evaluated by the APC ARP-01M Mednord device at the time of the admission, 30 min after the effect of an epidural anesthesia, an hour after the end of a surgery and a day after a surgery. Results. A perioperative dynamic monitoring of the state of a hemostatic balance showed that a preoperative hypercoagulation, compensated by an increased fibrinolysis, was replaced by a normocoagulation at the moment of a surgery, which was observed in the first hour after the end of a surgery and retained until the end of the first day. Conclusion. Hypercoagulation was found out for patients with BPH before a transvesical prostatectomy that was masked by an activation of the fibrinolytic system. The hemostatic potential assumed values identical to the reference values that should be taken into account prescribing a postoperative thromboprophylaxis against the background of a prolonged epidural blockade. The APC ARP-01M Mednord device allows you to assess all parts of a hemocoagulation at each stage of a perioperative treatment quickly and without high material costs.

Postthoracotomy pain in neonates has negative physiological consequences include impaired ventilation and vasoconstriction of both systemic and pulmonary vascular beds leading to compromised organ ...

aim. To assess the efficacy and safety of general associated balanced anesthesia based on epidural block during cesarean section in patients with “severe” mitral stenosis.Material and methods. The results of clinical observations, and a complex of clinical, functional and biochemical studies during cesarian section of 26 women aged 18-30 years, with a gestation period of 32-34 weeks had been studied. All patients had «severe» MS (according to A.N. Okorokov, s classifications). Depending on the method of anesthesia all patients were divided into two equal groups Patients of group I (n=13) were operated under conditions of associated balanced anesthesia (CBA) on the basis of epidural blockade (EB) patients of group II (n=13) were operated under conditions of one of the most common variants of multicomponent anesthesia (MCA). The operations were performed in a planned method, their durations made 35-60 minutes. The duration of anesthesia were 50-110 minutesResults. Significant advantages of CBA on the basis of EB became apparent: minimal expense of narcotic preparations and muscular relaxants: rapid rehabilitation of reflex muscular activity, making it possible to carry out extubations of trachea in earlier term: opportunity of using epidural catheter in postoperative period in order to receive prolonged postoperative analgesia. Conclusion. CBA on the basis of EB provides reliable antinociceptive protections of the body from surgical aggression, ensures a smooth course of anesthesia and early postoperative period and therefore has an obvious advantage over the traditional version of GMCA with AVL.K

Priapism is a clinical condition that rarely presents with leukemia in childhood. Management of priapism treatment can become more complex and difficult when accompanied by acute leukemia. We presented a 16 years old child with t-cell acute lymphoblastic leukemia (ALL) who developed priapism. Due to the failure of conservative methods and intracavernosal drainage, we performed epidural blockade which has limited data reported with successful results in the literature before shunt surgery. 2-s2.0-85111264615 34186129

Epidural blockade is a method often used in clinical practice to obtain pain relief during labor. Basically, the epidural puncture blocks the nerve impulses from the lower spinal segments with a consequent decrease of sensation in the lower half of the body. In this arena, the correct localization of the epidural space is crucial to perform the procedure. The loss of resistance (LOR) technique is the most popular approach to localize the epidural space. The LOR is caused by the fact that the ligamentum flavum is much harder than the epidural space, therefore when the needle tip pierces this ligamentum, there is an abrupt decrease of pressure (known as LOR). Although, there are several commercially available tools to support the clinicians in this task, the large part of epidural punctures is performed without any support. Our group of research has developed a novel and noninvasive tool to detect the LOR during epidural puncture. The aim of this study is to compare the output collected by the proposed system (i.e., the Epidural Space Management Tool, ESMT) with the output provided by a commercial system (i.e., CompuFlo®, Milestone Scientific, Inc.). Experiments were performed by an expert anesthesiologist (M.C.) on a simple simulator that allows mimicking the real scenario. Results showed a good agreement between the trends of the output of the two mentioned systems. Finally, the proposed system (ESMT), showed promising results in terms of LOR detection during all the five procedures performed on the simulator.

To investigation effects of the combination use of epidural blockade and parecoxib in postoperative recovery of colorectal cancer (CRC) patients.The present prospective single-blinded study included 186 CRC patients who received radical resection during April 2016 to December 2017. All patients were randomized into 3 different groups, the epidural blockade group, the combined-group with both epidural blockade and pre-intravenous injection of parecoxib, and the control group. The mean operative time, bleeding volume, the first out of bed activity time and hospital stay time were recorded. The mini-mental state examination (MMSE) score and Ramsay score were measured for cognitive function and the Visual Analog Score (VAS) was determined for the pain condition.The surgery time for the control group was significantly shorter than the other 2 groups (The combination of epidural blockade and parecoxib could enhance the recovery process, as well as reduce the pain for the CRC patients.

The article is devoted to the questions of epidural analgesia with the use of opioid analgesics. The work analyzes the clinical effectiveness of epidural use of opioids, lists possible complications and cautions of this method of anesthesia. Bioavailability of morphine and fentanyl for the spinal cord with epidural administration allows to achieve analgesic effects at a certain block level more effectively than with systemic administration. However, the side effects of opioids in the form of respiratory depression are also found with epidural administration (3%), so patient safety monitoring is necessary.

Работа посвящена рассмотрению вариантов лечения вертеброгенного болевого синдрома. Частая встречаемость его связана с изменениями условий жизни и работы в современном мире. Длительные осевые нагрузки на позвоночник, гиподинамия, повышенная масса тела негативно влияют на баланс позвоночного столба, что на начальном этапе выражается в появлении болевого синдрома. Авторы, в своей работе, выделяют основные виды блокады зависимости от их цели. Отдельно подчеркнуты современные технологические средства для верификации анатомических структур, позволяющие таргетированно воздействовать на источник боли. Описаны различные методы проведения блокад такие как эпидуральная, каудальная, трансфораминальная эпидуральная, миофасциальная, блокада крестцово-подвздошного сочленения, межпозвонковых суставов и грушевидной мышцы. Выделены показания к их применению, а также важные тактические нюансы. Проведен анализ возможностей применения различных лекарственных препаратов в купировании вертеброгенной боли. Указаны вероятные риски их применения. В заключении авторы подчеркивают важность малоинвазивных интервенционных вмешательств в комплексном лечении вертеброгенного болевого синдрома., The work is devoted to the consideration of treatment options for vertebrogenic pain syndrome. Its frequent occurrence is associated with changes in living and working conditions in the modern world. Prolonged axial loads on the spine, inactivity, increased body weight negatively affect the balance of the spinal column, which at the initial stage is expressed by the appearance of pain syndrome. The authors, in their work, distinguish the main types of blockades depending on their purpose. The modern technological means for verification of anatomical structures, allowing to target the source of pain, are emphasized separately. Various methods of blockade such as epidural, caudal, transforaminal epidural, myofascial, sacroiliac joint blockade, intervertebral joints and piriformis muscle are described. Indications for their use, as well as important tactical nuances are highlighted. The analysis of the possibilities of using various drugs in the relief of vertebrogenic pain has been conducted. The probable risks of their application are specified. In conclusion, the authors emphasize the importance of minimally invasive interventions in the complex treatment of vertebrogenic pain syndrome., Сибирский медицинский журнал, Выпуск 3 2019, Pages 17-22

Objectives This prospective, randomized, controlled study aimed to explore the efficacy of dexmedetomidine combined with epidural blockade on postoperative recovery of elderly patients after radical resection for colorectal cancer. Methods Ninety-six elderly patients who underwent radical resection for colorectal cancer were randomly divided into the following four groups: dexmedetomidine, epidural blockade (ropivacaine), combined (dexmedetomidine + epidural blockade), and control (0.9% saline). The Mini-Mental State Examination (MMSE), Visual Analog Scale (VAS), and Ramsay scores at 48 hours, and time to first activity, length of hospital stay, and postoperative complication rates at 3 months were assessed. Results Twelve hours after surgery, Ramsay scores were higher in the combined compared with the control and epidural blockade groups. Twenty-four hours after surgery, MMSE scores were higher in the combined compared with the other groups. The combined group showed the lowest VAS scores except at 48 hours. Time to first activity and length of hospital stay were significantly shorter in the combined compared with the other groups. There was no difference in total postoperative complication rates among the groups. Conclusions A combination of intraoperative dexmedetomidine infusion and epidural blockade could mitigate pain after surgery, improve cognitive dysfunction in early surgery, and facilitate recovery.

Purpose: Technology of reflectance spectroscopy incorporated with auto-fluorescence spectroscopy were employed to increase the safety of epidural placement in regional anesthesia which is generally used for surgery, epidural anesthesia, post-operative pain control and painless childbirth. Method: Ex vivo study of auto-fluorescence spectroscopy was performed for the para-vertebral tissues contained fat, interspinous ligament, supraspinous ligament and ligamentumflavum by multimode microplate reader at wavelength 405 nm for the purpose of tissue differentiation. A specially designed optic-fiber-embedded needle was employed to incorporate with both reflectance and autofluorescence spectroscopies in order to probe the epidural space as double assurance demands. In vivo study was carried out in a Chinese native swine weighted about 30 kg under intubated general anesthesia with ventilation support. The reflective (405 nm) and autofluorescence signals (&lambda, and &lambda, *) were recorded at 5 different sites by an oscilloscope during the needle puncture procedure from skin to epidural space in the back of the swine. Results: Study of either autofluorescence spectroscopy for tissue samples or ex vivo needle puncture in porcine trunk tissues indicates that ligmentumflavum has at least 10-fold higher fluorescence intensity than the other tissues. In the in vivo study, ligamentumflavum shows a double-peak character for both reflectance and autofluorescence signals. The epidural space is located right after the drop from the double-peak. Both peaks of reflectance and fluorescence are coincident which ensures that the epidural space is correctly detected. Conclusions: The fiber-optical technologies of double-assurance demands for tissue discrimination during epidural needle puncture can not only provide an objective visual information in a real-time fashion but also it can help the operator to achieve much higher success rate in this anesthesia procedure.

The landmark paper discussed in this chapter is ‘Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery’, published by Niemi and Breivik in 1998. The analgesic potential of neuraxial blockade has long been recognized. The extensive opioid receptor expression in areas germane to pain pathways gave credence to the effective clinical application of lower doses of neuraxial opioids compared with systemic administration. Preclinical data also proposed a potential spinal action of α‎2 agonists in achieving analgesia by a number of mechanisms, including a direct antinociceptive action and by reducing elution of other epidural drugs from the spinal effector site. Early clinical data failed to show a clear benefit from the addition of adrenaline to epidural infusions. Niemi and Breivik’s experiment addressed the methodological flaws of previous studies by using combinations of relatively sub-analgesic doses of each of the combined elements.

Pycnodysostosis is a rare congenital disorder with several implications, which might complicate anesthesia. Patients are more prone to fractures and have an anticipated difficult airway. We report a case of a 34-year-old woman with pycnodysostosis who underwent elective caesarean delivery under epidural blockade.

BACK GROUND: Epidural blockade is becoming one of the most useful and versatile procedures in modern anesthesiology . Levobupivacaine and Ropivacaine, the two new long - acting local anaesthetics, have been developed as an alternative to Bupivacaine, after the evidence of its severe toxicity. MATERIALS AND METHODS: It is prospective, randomized, double blind study on 90 Patients to evaluate th e time of onset and duration of sensory and motor blockade and hemodynamic effects of Bupivacaine 0.5% Ropivacaine 0.75% and Levobupivacaine 0.5% when administered epidurally for sub umbilical surgeries of age group 18 - 60yr of ASA I and II physical status un der epidural anesthesia . RESULTS: Ropivacaine has short duration of motor block when compared with Bupivacaine and Levobupivacaine. The onset of sensory and motor blocks, highest level of sensory block, degree of motor block and duration of sensory analgesia with Ropivacaine and Levobupivacaine are s imilar to that of Bupivacaine. The hemodynamic changes and side effect profile of Ropivacaine and Levobupivacaine is not significantly different from that of Bupivacaine. CONCLUSION : Ropivacaine and Levobupivacaine can be used as a safe alternative to Bupi vacaine , shorter duration of motor block with Ropivacaine suggest that it could be effectively used for early mobilization of patients in the post - operative period

INTRODUCTION: Pain is as old as mankind and so is the quest for its control. It is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. 1 Pain relief is a growing concern to anaesthesiologist, since no single analgesia is free from side effect, so it is a challenge to provide pain relief without much side effect like sedation, respiratory depression or problem like nausea & vomiting. Regional anaesthesia techniques generously offer adequate pain control for early mobilization and compliance with physiotherapy, they also provide additional benefits of decreased surgical stress response 2 improved myocardial stability, 3,4 rapid recovery of bowel function 5,6 and reduced risk of thromboembolic events like deep vein thrombosis and pulmonary embolism. 7 As a result it is also associated with reduction in postoperative morbidity and mortality. 8 Epidural anaesthesia has become increasingly popular in recent years for surgeries of lower abdomen, pelvis and lower limbs as it offer excellent operating conditions and is relatively safe for patients. It offers benefits in the form of greater hemodynamic stability and provision of postoperative analgesia via an epidural catheter. Clonidine is a partial α - 2 adrenergic agonist which, when administered by epidural route, has analgesic properties and potentiates the effect of local anesthetics . 9 Clonidine has analgesic effect at spinal level mediated by alpha - 2 adrenergic receptor situated in the postsynaptic dorsal horn of spinalcord. 10 It works by blocking the conductance of C & A fibres, increases the potassium ion in isolated neurons in - vitro and intensifies conductance block of local anaesthetics. 11 The aim of our study was to compare the quality and duration of analgesia, to assess the hemodynamic effects and to assess the incidence of side effects (sedation, post - operative nausea and vomiting ) when 2% lignocaine was used alone and in combination with clonidine in epidural blockade

During recent decades epidural analgesia has gained widespread recognition in many applications. In this complex procedure, anaesthetist uses a specific needle to inject anesthetic into the epidural space. It is crucial the appropriate insertion of the needle through inhomogeneous tissues placed between the skin and the epidural space to minimize anesthetic-related complications (e.g., nausea, headache, and dural puncture). Usually, anaesthetists perform the procedure without any supporting tools, and stop pushing the syringe when they sense a loss of resistance (LOR). This phenomenon is caused by the physical properties of the epidural space: the needle breaks the ligamentum flavum and reaches the epidural space, in this stage the anaesthetist perceives a LOR because the epidural space is much softer than the ligamentum flavum. To support the clinician in this maneuver we designed a non-invasive system able to detect the LOR by measuring the pressure exerted on the syringe plunger to push the needle up to the epidural space. In a previous work we described the system and its assessment during in vitro tests. This work aims at assessing the feasibility of the system for LOR detection on a more realistic model (ex vivo pig model). The system was assessed by analyzing: its ability to hold a constant value (saturation condition) during the insertion of the needle, and its ability to detect the entrance within the epidural space by a decrease of the system's output. Lastly, the anaesthetist was asked to assess how the ex vivo procedure mimics a clinical scenario. The system reached the saturation condition during the needle insertion; this feature is critical to avoid false positive during the procedure. However, it was not easy to detect the entrance within the epidural space due to its small volume in the animal model. Lastly, the practitioner found real the model, and performed the procedures in a conventional manner because the system did not influence his actions.

Epidural Analgesia is used for relief of pain during and following surgical operations, for relief of chronic pain, for relief of pain in labour, reduction of bleeding by producing sympathetic blockade and hypotension during surgery or to supplement light general anaesthesia, thereby suppressing the transmission of afferent impulses and autonomic and hormonal response to surgery. The commonly used drugs for epidural analgesia are 2% xylocaine and 0.5% bupivacaine. Mixing of the local anaesthetics and altering the pH have been found to be safe and cost effective.1,2 our study was a prospective randomized controlled double blind study to investigate effect of the benefits of usage of a compounded solution (2% xylocaine and 0.5% bupivacaine in a 1:1 ratio) over a single drug (0.5% bupivacaine) and ascertain whether it can be recommended for routine use in epidural analgesia in regular anaesthetic practice.3,4,5 The following parameters are Studied 1) The time of onset of analgesia. 2) The quality of analgesia. 3) The degree of motor blockade. 4) Duration of analgesia. 5) Safety of compounding local anaesthetics. METHODS AND MATERIAL: One Hundred Adult Patients of either sex ranging between 20-60 years of age belonging to ASA grade 1 and II were studied. All patients were at random divided into 2 groups fifty in each group. Group A received 0.5% bupivacaine 15cc. Group B received a mixture of 0.5% bupivacine and 2% xylocaine (7.5cc + 7.5cc) RESULTS: Mean time of onset of analgesia in group B was lower (11.50 + 2.05) as compared to group A (22.24 + 2.18) and this difference was statistically highly significant (P

Case report on 14 years old girl with type 1 complex regional pain syndrome (CRPS) is presented. At first admission in 5.5 months after right hand injury and development of type 1 CRPS, paravasal sympathectomy on the right upper extremity was performed. Complete elimination of pain syndrome and restoration of the extremity function was achieved. Five and a half months after discharge the left foot and in 3 weeks later the right hand were injured. In both cases injuries were accompanied by pronounced CRPS clinical picture. At second admission in 6 weeks after foot injury interventional treatment with placement of catheters next to nerve trunks and bolus administration of antibiotics was performed for 1 week and enabled to achieve remission of the disease. It was noted that not only hypersymphaticotony but also psychological status of a patient were important for the disease development.

The breakage of an epidural catheter, which is usually not noticed, is a rare but important complication encountered while inserting or removing the catheter during epidural blockade. While the epidural catheter was being inserted for labor analgesia, despite no problem being encountered in advancing the catheter, it was drawn back to verify the location; it was observed that 2 cm of the distal end of the catheter was missing. A neurosurgical consultation was requested; it was reported that the broken piece would not create any problems and reintervention could be performed for labor analgesia. An epidural catheter was reinserted and was used for analgesia without any problem until delivery. Although nine months have passed, no problem was defined by the patient. If epidural catheter has to be removed while the Tuohy needle is still in place, we recommend that they should be removed together to minimize the risk of a possible breakage. We think that the decision for surgery and imaging can be performed based on the individual patient’s clinical picture.

Background Epidural needle insertion is usually a blind technique where the rate of adverse events depends on the experience of the operator. A novel ultrasound method to guide epidural catheter insertion is described. Methods An ultrasound transducer (40 MHz, a -6 dB fractional bandwidth of 50%) was placed into the hollow chamber of an 18-gauge Tuohy needle. The single crystal was polished to a thickness of 50 μm, with a width of 0.5 mm. Tissue planes were identified from the reflected signals in an A-mode display. The device was inserted three times into both the lumbar and thoracic regions of five pigs (average weight, 20 kg) using a paramedian approach at an angle of 35-40°. The epidural space was identified using signals from the ligamentum flavum and dura mater. Epidural catheters were placed with each attempt and placement confirmed by contrast injection. Results The ligamentum flavum was identified in 83.3% of insertions and the dura mater in all insertions. The dura mater signal was stronger than that of the ligamentum flavum and served as a landmark in all epidural catheter insertions. Contrast studies confirmed correct placement of the catheter in the epidural space of all study animals. Conclusions This is the first study to introduce a new ultrasound probe embedded in a standard epidural needle. It is anticipated that this technique could reduce failed epidural blocks and complications caused by dural puncture.

Objectives: The aim of this study was to evaluate the effects of hyaluronidase added to levobupivacaine in lumbosacral epidural blockade in dogs. Methods: Six adult mixed breed dogs (two males and four females) weighing 7 to 14 kg (10·5 ±1·5 kg) and aged two to five years were used. Each dog received both treatments in random order: levobupivacaine alone (LBA; n=6) or levobupivacaine plus hyaluronidase (LBH; n=6) administered in the lumbosacral epidural space. Systemic effects, spread and duration of anaesthesia and motor block were determined before treatment and at predetermined intervals. Results: The duration of local anaesthesia was 90 ±10 minutes (P=0·001) for LBH treatment and 150 ±15 minutes for LBA treatment. In the LBH treatment, anaesthesia reached the T12 to T13 dermatome and in the LBA treatment it reached the T11 to T12 dermatome in all animals in 5 and 15 minutes, respectively. Complete motor blockade was 75 ±12 minutes (P=0·01) and 120 ±15 minutes for LBH and LBA treatments, respectively. Clinical Significance: Hyaluronidase added to levobupivacaine significantly shortens the duration of epidural anaesthesia with the same dermatome spread into the epidural space in dogs.

The conversion of epidural analgesia during labour to surgical anaesthesia for Caesarean section can have important medical and medicolegal implications. This survey sought to establish the current management for extending epidural blockade for emergency Caesarean section. A postal questionnaire was sent to the lead obstetric anaesthetist in all maternity units in the UK (n = 254). The response rate was 82% (n = 209). Of those surveyed, 68% (136) give the full dose of the local anaesthetic mixture in the delivery room, whilst 12.5% (25) initiate the top-up in the delivery room and give the remainder of the dose in theatre. Fifteen per cent (30) transfer the woman to theatre before commencing anaesthesia and 34% (68) give a test dose before the full anaesthetic dose. Guidelines for converting labour analgesia to anaesthesia for emergency Caesarean section were available in 64% (128) units. Bupivacaine 0.5% was the most commonly used agent, being used as the sole agent by 41.5% (81) units and in combination by a further 18% (36). Adrenaline was added to the chosen local anaesthetic by 30% (60) whilst 12% (24) added bicarbonate. In all, 13 combinations of local anaesthetics and adjuncts were used. The mode time to transfer the patient to theatre was 1 min. Of the 161 respondents who commenced anaesthesia in the delivery room, 71% (114) did not monitor the patient during transfer, whilst 87% (140) had ephedrine immediately available. Thirty-three respondents reported a total of 43 adverse incidents associated with the extension of epidural blockade. These included high blocks, inadequate blocks and possible intravascular injections, the latter resulting in two seizures and one cardiac arrest.

While there have been previous studies looking at patterns of litigation against anaesthetists overseas, there is little reported on the trends in Australia. This study was performed to ascertain current reporting rates of anaesthetic incidents, and from what areas these reports arise. Over the five years spanning January 1999 until December 2003, 1,231 adverse anaesthetic outcomes were reported to United Medical Protection by Australian anaesthetists. As in other studies, damage relating to airway instrumentation was the most frequently reported, comprising 261 incidents (21.8%). Complications related to epidural blockade were the next most common, accounting for 182 outcomes (15.2%). Other common areas generating incident reports included nerve injuries, respiratory complications, drug side-effects and death. To date 147 claims (12.3%) have arisen from these incident reports. Knowledge of these areas of risk should translate into more effective risk management with reduction in claims and adverse patient outcomes.

Caudal epidural blockade remains the cornerstone of pediatric regional anesthesia. In this article we provide a comprehensive review of the recent developments in caudal anesthesia in infants and children.Research has focused on prolonging the duration of single-shot caudal blocks and accurately positioning continuous caudal catheters. New local anesthetics with similar potencies but less toxicity have been introduced. Opioids prolong the duration of analgesia of local anesthetic, but have also been associated with unacceptable side effects, particularly in pediatric outpatients. Various non-opioid adjuncts with more favorable side-effect profiles may increase the duration of analgesia. New ultrasound and nerve-stimulation techniques have been developed to accurately guide epidural catheters to a specific spinal level.The addition of ketamine or clonidine to a caudal local anesthetic prolong the duration of the block. However, a preservative-free preparation of ketamine that is suitable for neuraxial use is not widely available. Ultrasound imaging and electrical stimulation are promising options to accurately position a caudal needle. However, because ultrasound imaging is more difficult in older children, nerve stimulation is a more-suitable technique to accurately guide caudal catheters in this patient population. Although complications associated with caudal block are rare, the risks and benefits must be carefully considered on an individual basis.