Effect of paediatric caudal injection volume on optic nerve sheath diameter and regional cerebral oximetry: A randomised trial.

ABSTRACT

BACKGROUND: Caudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO 2 ) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure. OBJECTIVES: Comparing how caudal injection volumes of 0.8 and 1.25 ml kg -1 influence ONSD and CrSO 2 within the first 30 min after injection. DESIGN: Prospective, randomised and parallel group trial. SETTING: Operating room. PATIENTS Fifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single - shot caudal anaesthesia. INTERVENTION Single-shot caudal anaesthesia with 0.8 ml kg -1 (group L, n  = 29) and 1.25 ml kg -1 (group H, n  = 29) of 2 mg kg -1 bupivacaine solution. MAIN OUTCOME MEASURES: Optic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near - infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block. RESULTS: Mean ONSD values increased from a baseline of 4.4 ±â€Š0.2 mm to a maximum of 4.5 ±â€Š0.2 mm 20 min after injection in group L and from a baseline of 4.5 ±â€Š0.3 mm to a maximum of 4.8 ±â€Š0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO 2 . CONCLUSION: Caudal injection with 1.25 ml kg -1 increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg -1 and neither volume caused a clinically important reduction in CrSO 2 . TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04491032.