Ultrasonography versus conventional palpation for epidural analgesia in pediatrics undergoing midabdominal urological operations: a randomized clinical trial.

Background: Epidural block may be facilitated by ultrasound (US), particularly in pediatrics. Our goal was to compare pre-procedural US with traditional palpation for epidural block in pediatrics undergoing midabdominal urological procedures.

Methods: A total of 110 patients (1 to 12 years of age) with physical status Class I and II were enrolled in this study. Patients were randomly assigned to 2 equal groups (US and palpation; 55 subjects in each group) using the permuted block randomization method with randomly selected block sizes of four and six. Study subjects and outcomes evaluators were blinded to the study group. The primary outcome was the rate of successful epidural block at the first needle pass.

Results: There was a significant increase in success rate of the epidural block at the first needle pass in US group compared with the palpation group, 80% and 47.3% respectively, 95% Confidence Interval (2.379-8.35), P value ˂0.001. The epidural space detection time was shorter significantly in the US group compared to the palpation group. The procedural complications (unintentional vascular puncture and epidural puncture) did not occur in the 2 groups.

Conclusions: Preprocedural US facilitated epidural block in pediatrics undergoing mid-abdominal urological operations compared with conventional techniques.