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To Study and Compare the Reliability of Four Different Techniques for Identifying the Correct Needle Placement in Caudal Epidural Space-Loss of Resistance, Whoosh Test, Swoosh Test and Nerve Stimulation in Paediatric Age Group


Affiliations
1 Department of Anaesthesiology, Dr Yashwant Singh Parmar Medical College and Hospital Nahan, Sirmour, Himachal Pradesh, India
2 Department of Anaesthesiology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India

Background: Precise knowledge of anatomical land marks of sacral hiatus and the proper identification of the epidural space is indispensable for successful caudal epidural anaesthesia. Aim: To test the reliability of loss of resistance, whoosh test, swoosh test and nerve stimulation in identifying the correct caudal needle placement in children. Methods: 40 children aged between 1-6 years with ASA-I and ASA-II undergoing infra umbilical surgical procedures studied. On completion of surgery under general anaesthesia, neuromuscular blockade was reversed and caudal given. Nerve stimulator needle was inserted with Loss of Resistance (LOR) as reference and gradually current increased until a motor response visible in the anal sphincter (S2-S3). Then, whoosh and swoosh test performed by another observer blinded and local anaesthetic given using Armitage formula. Results: LOR was appreciated in 34 (85%) patients. Elicitation of nerve stimulation test was positive in all 40 (100%) of patients. The mean current used was 7.47 ± 2.52 mA. The whoosh test (1ml of air) and swoosh test was positive in all 40 (100%) of the patients. In one patient sacral hiatus could not be identified. The most frequent difficulty noticed was multiple attempts in six out of 20 cases. Conclusion: LOR technique requires experience, thus not a good teaching tool for beginners. Nerve stimulator is an excellent objective tool however; limited availability and time constraints make its use impractical. Whoosh and swoosh are the preferred clinical techniques if ultrasound is unavailable.

Keywords

Caudal, Loss of Resistance, Nerve Stimulator, Swoosh, Whoosh.
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  • To Study and Compare the Reliability of Four Different Techniques for Identifying the Correct Needle Placement in Caudal Epidural Space-Loss of Resistance, Whoosh Test, Swoosh Test and Nerve Stimulation in Paediatric Age Group

Abstract Views: 478  |  PDF Views: 178

Authors

Anupam Sharma
Department of Anaesthesiology, Dr Yashwant Singh Parmar Medical College and Hospital Nahan, Sirmour, Himachal Pradesh, India
Surinder Singh
Department of Anaesthesiology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
Sonali Kaushal
Department of Anaesthesiology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India

Abstract


Background: Precise knowledge of anatomical land marks of sacral hiatus and the proper identification of the epidural space is indispensable for successful caudal epidural anaesthesia. Aim: To test the reliability of loss of resistance, whoosh test, swoosh test and nerve stimulation in identifying the correct caudal needle placement in children. Methods: 40 children aged between 1-6 years with ASA-I and ASA-II undergoing infra umbilical surgical procedures studied. On completion of surgery under general anaesthesia, neuromuscular blockade was reversed and caudal given. Nerve stimulator needle was inserted with Loss of Resistance (LOR) as reference and gradually current increased until a motor response visible in the anal sphincter (S2-S3). Then, whoosh and swoosh test performed by another observer blinded and local anaesthetic given using Armitage formula. Results: LOR was appreciated in 34 (85%) patients. Elicitation of nerve stimulation test was positive in all 40 (100%) of patients. The mean current used was 7.47 ± 2.52 mA. The whoosh test (1ml of air) and swoosh test was positive in all 40 (100%) of the patients. In one patient sacral hiatus could not be identified. The most frequent difficulty noticed was multiple attempts in six out of 20 cases. Conclusion: LOR technique requires experience, thus not a good teaching tool for beginners. Nerve stimulator is an excellent objective tool however; limited availability and time constraints make its use impractical. Whoosh and swoosh are the preferred clinical techniques if ultrasound is unavailable.

Keywords


Caudal, Loss of Resistance, Nerve Stimulator, Swoosh, Whoosh.

References