Comparison of effectiveness of pediatric caudal block with ultrasound guidance versus landmark technique.

Objective: To compare the efficacy of ultrasound guidance versus landmark technique for performing caudal block in children undergoing infraumbilical surgery. Study Design: Non Randomized Controlled Trial. Setting: Institute of Child Health and Children Hospital, Faisalabad. Period: January 2025 – April 2025. Methods: After institutional ethical approval, 240 children aged 2 to 10 years were randomly assigned to two equal groups: Group USG (ultrasound-guided) and Group LM (landmark technique). Caudal block was administered under general anesthesia in both groups. Primary outcome was success on first attempt; secondary outcomes included performance time, incidence of tachycardia (defined as ≥10% rise in heart rate during skin incision), and number of needle punctures. Data were analyzed using SPSS version 23. Results: No significant difference was found between the groups in terms of age, weight, and gender. The USG group showed a significantly higher success rate on the first attempt (95% vs. 70.83%, p = 0.000) and a lower incidence of tachycardia (10% vs. 32%, p = 0.000). However, time taken was significantly longer in the USG group (110.88 ± 16.11 sec vs. 63.62 ± 13.10 sec, p = 0.000). Conclusion: Ultrasound guidance significantly increases the success rate of pediatric caudal block compared to landmark technique, although it requires more time to perform.