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DP20: THE EFFICACY OF BIPLANE VERSUS SINGLE-PLANE ULTRASOUND IN FACILITATING CAUDAL EPIDURAL ANESTHESIA IN PEDIATRIC PATIENTS
Sonia Mehta, MD; Anjali Patel
University of Florida Department of Anesthesiology
Background: Ultrasound guidance is instrumental in performing caudal epidural blocks in pediatric patients. Single-plane ultrasound provides a single imaging perspective, while biplane ultrasound offers simultaneous transverse and longitudinal visualization. Enhanced biplane visualization may lead to higher first-attempt caudal needle placement success rates, reduced procedure time, and prolonged duration to first postoperative analgesic administration. This study compared the efficacy of biplane versus single-plane ultrasound in facilitating caudal epidural anesthesia in pediatric patients.
Methods: 46 pediatric patients were enrolled into an IRB-approved randomized controlled trial. The study employed a parallel assignment intervention model, utilizing the Butterfly IQ biplane ultrasound used in the single or biplane mode depending on the assigned study group. The caudal space was accessed using a 22 ga 35 mm length needle (MFGR). Inclusion criteria comprised male patients aged 4 months to 10 years undergoing elective circumcision with ASA status I or II. Exclusion criteria included anatomical abnormalities (e.g., tethered cord, sacral malformations), coagulopathies, preoperative analgesic use, local anesthetic allergies, and infection at the injection site.
Primary efficacy outcomes were first-attempt success rate, number of needle redirections, and time from probe placement to successful injection. Secondary outcomes included postoperative pain assessments using the FLACC scale and time to first analgesic administration within 24 hours of discharge. Safety endpoints included the incidence of epidural hematoma, local anesthetic toxicity, nausea, vomiting, hypotension, total spinal anesthesia, and dural puncture. Additionally, post-discharge follow-up calls assessed patient recovery and satisfaction.
Results: We found no statistically significant difference between Group A (single-plane) and Group B (biplane) imaging in first-attempt success rate, number of needle redirections, or procedure time. The Butterfly Network biplane probe was found to be less compatible with the small body habitus of pediatric patients due to its larger diameter and the short needle length used for the procedure. Suboptimal image resolution further impeded needle visualization, and operator (n=4) variability contributed to performance differences. Patient age, weight, and height did make a difference between the success rates of Group A and Group B.
Conclusion: The Butterfly IQ Biplane ultrasound did not provide a significant advantage over single-plane ultrasound for caudal epidural anesthesia in pediatric patients. However, patient age, weight, and height appear to influence procedural outcomes and warrant further investigation. Future studies targeting differences in the specific demographics (age, weight, and height) will better elucidate any potential differences between single-plane and biplane imaging during caudal placement.