Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study

Abstract Introduction Caudal epidural block is a widely performed procedure for postoperative pain control of pediatric patients. As the local anesthetic acts by spreading cranially after caudal block, it may lead to several effects on the cerebrospinal fluid and intracranial region. Method Children...

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Main Authors: Ahmet Murat Yayik, Elif Oral Ahiskalioglu, Erkan Cem Celik, Mirac Selcen Ozkal Yalin, Binali Firinci, Irem Ates, Muhammed Enes Aydin, Ali Ahiskalioglu
Format: Article
Language:English
Published: BMC 2025-03-01
Series:BMC Anesthesiology
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Online Access:https://doi.org/10.1186/s12871-025-03007-z
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author Ahmet Murat Yayik
Elif Oral Ahiskalioglu
Erkan Cem Celik
Mirac Selcen Ozkal Yalin
Binali Firinci
Irem Ates
Muhammed Enes Aydin
Ali Ahiskalioglu
author_facet Ahmet Murat Yayik
Elif Oral Ahiskalioglu
Erkan Cem Celik
Mirac Selcen Ozkal Yalin
Binali Firinci
Irem Ates
Muhammed Enes Aydin
Ali Ahiskalioglu
author_sort Ahmet Murat Yayik
collection DOAJ
description Abstract Introduction Caudal epidural block is a widely performed procedure for postoperative pain control of pediatric patients. As the local anesthetic acts by spreading cranially after caudal block, it may lead to several effects on the cerebrospinal fluid and intracranial region. Method Children aged 1–7, ASA I-II were included in this study. The patient population was assigned into two groups as the Caudal Block Group (Group CB) and the Control Group (Group C) Caudal block with 0.25% bupivacaine 1 ml/kg was performed on patients in Group CB. Optic nerve sheath diameter was measured at the following timeline: T0: Following laryngeal mask placement, T1: Following caudal block. T15:15. min, T30:30. min. Heart rate, non-invasive blood pressure, SpO2 and PCO2 values were also recorded at every time point. Results There was no significant difference between two groups considering demographic data, intraoperative hemodynamic parameters, intraoperative SpO2 and PCO2 values. While optic nerve sheath diameter findings were not significantly different between the groups at T0 and T1 points(P > 0.05), the measurements at T15(4.18 ± 0.56 for Group C and 4.62 ± 0.47 for Group CB, P = 0.006) and T30(4.20 ± 0.53 for Group C and 4.76 ± 0.52 for Group CB) were statistically higher in the Caudal Group. Conclusion Evaluation of optic nerve sheath diameter has high diagnostic precision for detecting increased intracranial pressure in children. The findings in this study display that local anesthetic applied for caudal block in pediatric surgeries spread cranially resulting in an increase in the intracranial pressure and optic nerve sheath diameter. However, this increase does not cause intraoperative hemodynamic changes.
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spelling doaj-art-07efdb82ae304873a09ce4d305544b6a2025-08-20T03:41:50ZengBMCBMC Anesthesiology1471-22532025-03-012511710.1186/s12871-025-03007-zEvaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled studyAhmet Murat Yayik0Elif Oral Ahiskalioglu1Erkan Cem Celik2Mirac Selcen Ozkal Yalin3Binali Firinci4Irem Ates5Muhammed Enes Aydin6Ali Ahiskalioglu7Department of Anesthesiology and Reanimation, Ataturk University School of MedicineDepartment of Anesthesiology and Reanimation, Ataturk University School of MedicineDepartment of Anesthesiology and Reanimation, Ataturk University School of MedicineDepartment of Anesthesiology and Reanimation, Ataturk University School of MedicineDepartment of Pediatric Surgery, Ataturk University School of MedicineDepartment of Anesthesiology and Reanimation, Ataturk University School of MedicineDepartment of Anesthesiology and Reanimation, Ataturk University School of MedicineDepartment of Anesthesiology and Reanimation, Ataturk University School of MedicineAbstract Introduction Caudal epidural block is a widely performed procedure for postoperative pain control of pediatric patients. As the local anesthetic acts by spreading cranially after caudal block, it may lead to several effects on the cerebrospinal fluid and intracranial region. Method Children aged 1–7, ASA I-II were included in this study. The patient population was assigned into two groups as the Caudal Block Group (Group CB) and the Control Group (Group C) Caudal block with 0.25% bupivacaine 1 ml/kg was performed on patients in Group CB. Optic nerve sheath diameter was measured at the following timeline: T0: Following laryngeal mask placement, T1: Following caudal block. T15:15. min, T30:30. min. Heart rate, non-invasive blood pressure, SpO2 and PCO2 values were also recorded at every time point. Results There was no significant difference between two groups considering demographic data, intraoperative hemodynamic parameters, intraoperative SpO2 and PCO2 values. While optic nerve sheath diameter findings were not significantly different between the groups at T0 and T1 points(P > 0.05), the measurements at T15(4.18 ± 0.56 for Group C and 4.62 ± 0.47 for Group CB, P = 0.006) and T30(4.20 ± 0.53 for Group C and 4.76 ± 0.52 for Group CB) were statistically higher in the Caudal Group. Conclusion Evaluation of optic nerve sheath diameter has high diagnostic precision for detecting increased intracranial pressure in children. The findings in this study display that local anesthetic applied for caudal block in pediatric surgeries spread cranially resulting in an increase in the intracranial pressure and optic nerve sheath diameter. However, this increase does not cause intraoperative hemodynamic changes.https://doi.org/10.1186/s12871-025-03007-zCaudal epidural blockOptic nerve sheath diameterNon-invasive intracranial pressure monitoring
spellingShingle Ahmet Murat Yayik
Elif Oral Ahiskalioglu
Erkan Cem Celik
Mirac Selcen Ozkal Yalin
Binali Firinci
Irem Ates
Muhammed Enes Aydin
Ali Ahiskalioglu
Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study
BMC Anesthesiology
Caudal epidural block
Optic nerve sheath diameter
Non-invasive intracranial pressure monitoring
title Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study
title_full Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study
title_fullStr Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study
title_full_unstemmed Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study
title_short Evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients: randomized controlled study
title_sort evaluating the effect of caudal epidural block on optic nerve sheath diameter in pediatric patients randomized controlled study
topic Caudal epidural block
Optic nerve sheath diameter
Non-invasive intracranial pressure monitoring
url https://doi.org/10.1186/s12871-025-03007-z
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