ArticleLocal and regional anesthesia2026
Correlation Between Injected Volume and Cranial Spread in Broad-Aged Pediatric Caudal Anesthesia: A Retrospective Ultrasound-Guided Study.
Article in Local and regional anesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Caudal block remains a standard regional anesthesia technique for pediatric lower abdominal and lower limb surgeries. The conventional weight-based Armitage formula does not consider patient body habitus, which can lead to under- or over-dosing-especially in lean or obese children. Ultrasound guidance permits visualization of epidural spread and may facilitate individualized dosing. Patients and Methods: In this retrospective single-center study, anesthetic records of 25 pediatric patients (age 10-106 months) undergoing ultrasound-guided caudal blocks for lower abdominal or lower extremity surgery were analyzed. Volumes of 0.25% levobupivacaine required to achieve cranial spread to vertebral levels S1, L2 and L1 were recorded. Univariate and multivariate linear regression models, incorporating weight, height, age, and BMI, were compared using adjusted R Results: Univariate regression revealed injected volume correlated strongest with weight: for S1 spread, volume = 0.1458 × weight (kg) (p = 0.006); for L2 spread, volume = 0.4898 × weight (kg) (p = 0.0079). The optimal multivariate model for S1-level spread combined weight and height: Volume (mL) = 0.1741 × weight (kg) - 0.0234 × height (cm) (adjusted R Conclusion: In pediatric caudal anesthesia, a dosing formula that uses both weight and height improves prediction of the volume required for S1-level blocks, whereas a weight-based formula is adequate for L2-level spread. Real-time ultrasound guidance enhances procedural accuracy and safety by confirming epidural spread and detecting anatomical variation. These data support development of an individualized dosing nomogram for pediatric caudal anesthesia.
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