Question

A 4-year-old boy with midshaft hypospadias is for repair. As part of the anesthetic, a single-shot caudal will be administered after induction, but prior to incision. Which of the following is most accurate with respect to this neuraxial block?

A. Significant hypotension is likely in the absence of fl uid loading.
B. Test dosing with epinephrine is highly sensitive for intravascular placement.
C. The cephalad extent of the block is infl uenced primarily by local anesthetic concentration.
D. The sacrococcygeal ligament must be punctured.
E. The dural sac terminates at S3-4.

Answer 1

The sacrococcygeal ligament must be punctured for the administration of a single-shot caudal block in a child. This technique is used for pain relief in pediatric surgeries involving areas served by the lower spinal segments.

Step-by-step explanation:

The most accurate statement concerning the single-shot caudal block before hypospadias repair in a 4-year-old boy is D. The sacrococcygeal ligament must be punctured. The caudal block, a type of epidural anesthesia administered in the sacral hiatus, requires penetration of the sacrococcygeal ligament to reach the epidural space in the caudal canal. This technique is commonly used for analgesia in pediatric surgeries involving the lower abdomen, perineum, and lower extremities.

As for the other options: A) Significant hypotension is not likely due to the small volume of local anesthetic used in pediatric patients; B) Test dosing with epinephrine is not as sensitive in children due to their variable heart rate responses; C) The extent of the block is influenced more by the volume of local anesthetic than by its concentration; E) The dural sac typically terminates at the level of S2 in most individuals, not S3-4.