Caudal Block Guidelines

Dosing Recommendations

The American Society of Anesthesiologists recommends bupivacaine 0.25% at a dose of 1.0 ml/kg for caudal blocks in children 1, 2, 3
The American Society of Anesthesiologists recommends levo-bupivacaine 0.25% at a dose of 1.0 ml/kg for caudal blocks in children 1, 2
The American Society of Anesthesiologists recommends ropivacaine 0.2% at a dose of 1.0 ml/kg for caudal blocks in children 1, 2

The maximum dose of bupivacaine 0.25% for peripheral nerve blocks and wound infiltration is 1 ml/kg (equivalent to 2.5 mg/kg), as recommended by the American Society of Anesthesiologists 3, 4
The American Society of Anesthesiologists recommends not exceeding the maximum dose of bupivacaine 0.25% to prevent local anesthetic toxicity 3, 5

The American Society of Anesthesiologists recommends adding preservative-free clonidine at a dose of 1 to 2 micrograms/kg to enhance and prolong the analgesic effect 1, 2, 5
The American Society of Anesthesiologists recommends adding morphine at a dose of 30 to 50 micrograms/kg (only with adequate monitoring for respiratory depression) to enhance and prolong the analgesic effect 1, 2

The American Society of Anesthesiologists recommends using 1.0 ml/kg of 0.25% bupivacaine for optimal spread in procedures requiring mid-to-lower abdominal coverage 1, 2

The American Society of Anesthesiologists recommends a continuous rate of bupivacaine 0.25% at 0.1-0.3 ml/kg/h for continuous caudal analgesia with adequate monitoring 2, 5
The American Society of Anesthesiologists recommends adding preservative-free clonidine at a dose of 0.2 to 0.4 micrograms/kg/h for continuous caudal analgesia with adequate monitoring 2, 5

The American Society of Anesthesiologists recommends always calculating the total dose in mg/kg to ensure it remains below the toxic threshold 4
The American Society of Anesthesiologists recommends ensuring appropriate monitoring for potential complications 2
The American Society of Anesthesiologists recommends aspirating before injection to avoid intravascular administration 3
The American Society of Anesthesiologists recommends considering using a test dose with epinephrine to detect intravascular injection 3