الفهرس 
ANATOMY OF CAUDAL CANALOnly 14 pages are availabe for public view
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Abstract
Caudal anesthesiais one of the most popular regional blocks in children. This technique is usually performed after an inhaled or IV induction and is a usefuladjunct during general anesthesia and for providing postoperative analgesia after genital, lower abdominal, and lower limb operations. The quality and level of the caudal blockade is dependent on the dose, volume, and concentration of the injected drug.
The primary local anesthetic agents usedin pediatric regional techniques are 2-chloroprocaine, lidocaine, bupivacaine, ropivacaine, mepivacaine, and tetracaine. Levobupivacaine has recently been used and may replacae the racemic mixture of bupivacaine because of its decreased potential for central nervous system toxicity and cardiotoxicity. All local anesthetics block the generation and propagation of impulses in excitable tissues.
Single-shot caudal anaesthesia with local anaesthetic (bupivacaine) is the most commonly used regional technique for intraoperative and postoperative pain relief in children. The popularity of this technique is due to its simplicity and frequent success. However, the single-shot ”kiddie caudal” may have only a short duration of action. Placement of a catheter into the caudalepidural space adds to the risk of infection and tends to prevent early mobilization.
Prolongation of analgesia by using this technique has been achieved by the addition of various adjuvants. The addition of opioids significantly prolongs the duration of caudal analgesia; however, it has a number of unpleasant side effects, as well as the risk of late respiratory depression. Attempts to overcome these problems by combining bupivacaine with other non-opioids, such as clonidine, ketamine, midazolam, and neostigmine have met with different degrees of success.
There are many parameters used to evaluate the effectiveness of caudal anesthesia which applied for postoperative analgesia, two of those parameters are MBP and HR. Generally, at the beginning of a surgical procedure, a 15-20% or more increase of these two parameters compared to baseline is considered to be an insufficient block. Effects of local anesthetics on MBP and HR values are similar and no significant difference was found.