Ultrasound-Guided versus Conventional Landmark Caudal Epidural Block in Pediatrics: A Narrative Review of Success Rate, Safety, and Clinical Considerations
Iranian Journal of Pediatric Surgery,
Vol. 12 No. 2 (2026),
3 November 2026
,
Page 111 - 130
https://doi.org/10.22037/irjps.v12i2.52895
Abstract
Introduction: Caudal blockade remains a widely utilized regional anesthetic technique in pediatric practice, employed both for the provision of surgical anesthesia and for the management of perioperative pain. Caudal block is a safe and easily administered regional technique in children, associated with low postoperative pain scores. When combined with general anesthesia, it reduces the need for inhaled medications, opioids, improved postoperative analgesia, and more rapid endotracheal tube removal. Historically, the landmark-guided approach has served as the standard method for this block, offering ease of performance and acceptable efficacy, albeit with recognized complications including unintentional dural perforation and vascular injection. Ultrasound-guided caudal blockade, by contrast, is associated with superior success rates and a lower incidence of these complications.
Materials and Methods: This narrative review synthesizes evidence comparing ultrasound-guided and landmark-based techniques for caudal block in pediatric patients, with respect to success rate, safety, and complications.
Results: Current clinical data and meta-analyses indicate that while overall success rates can be high for both, ultrasound offers significant advantages in precision. Ultrasound consistently results in a higher first-puncture success rate and a reduced number of needle manipulations. Regarding safety real-time visualization significantly lowers the risk of vascular punctures, accidental dural punctures, and rectal perforation. Clinical considerations highlight that ultrasound is especially beneficial for patients with obesity or anatomical anomalies where palpable landmarks are unreliable. Although the landmark technique is sometimes faster by a matter of seconds, the immediate confirmation of injectate spread provided by ultrasound enhances overall reliability.
Conclusion: ultrasound provides superior accuracy and safety, supporting its routine use to optimize pediatric anesthetic outcomes.
- regional anesthesia
- caudal block
- pediatric
- ultrasound-guided
- landmark technique
How to Cite
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