Anaes · Paediatric anaesthesia
Paediatric regional anaesthesia: caudal block dosing and safety
Also known as Armitage caudal dosing · Paediatric caudal block · Infant regional anaesthesia
Caudal anatomy and landmark versus ultrasound technique, exact Armitage volume dosing by block height, local anaesthetic mg/kg limits, test-dose limitations, LAST recognition and lipid therapy, and GAS trial context for infant regional anaesthesia.
Practise this topic
On this page & tools
Your progress
Saved locally on this device.
10 MCQs with explanations
Target exams
Red flags
Meet the patient
A 10 kg infant for bilateral orchidopexy. The registrar proposes 1.25 mL/kg of 0.25% bupivacaine for a good high block. Do the maths before you draw up: 12.5 mL at 2.5 mg/mL equals 31.25 mg equals 3.125 mg/kg — over the 2.5 mg/kg ceiling. That plan will poison the child.[3]
The fellowship answer is always the same: calculate milligrams first, then see if Armitage volume fits at a dilute concentration. If it does not, redesign — dilute, reduce volume, lower the target, or choose another technique. This single algorithm prevents almost every caudal toxicity disaster.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
References5Show ledgerHide ledger
- [1]Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS). Lancet, 2016.PMID 26507180
- [2]McCann ME, de Graaff JC, Dorris L, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS). Lancet, 2019.PMID 30782342
- [3]Koo BN, Hong JY, Kil HK Spread of ropivacaine by a weight-based formula in a pediatric caudal block: a fluoroscopic examination. Yonsei Medical Journal, 2010.PMID 20236099
- [4]Sikich N, Lerman J Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale. Anesthesiology, 2004.PMID 15114210
- [5]Flick RP, Wilder RT, Pieper SF, et al. Risk factors for laryngospasm in children during general anesthesia. Paediatric Anaesthesia, 2008.PMID 18315633