J. Coe, S. Y. Ong, A. Baxter

NHS Lothian, Edinburgh, UK

Background, context & problem

Caudal anaesthesia was first described in 1933 and accounts for 34-40% of paediatric regional anaesthesia. [1] This has traditionally been a landmark based technique using a peripheral IV cannula or similar with a success rate above 96%. [2] An NPSA patient safety alert in 2011 and 2017 required the NHS to transition to the use of non-Luer connectors for neuraxial and regional anaesthesia equipment. [3] This has been reinforced with a joint statement from the RCOA and the Safe Anaesthesia Liason Group in 2022 stating that the use of NRfit is expected to be in the ‘future criteria of the Royal College of Anaesthetists’ Guidelines for the Provision of Anaesthetic Services and ACSA standards and in the future guidelines of the Association of Anaesthetists’. [4] Given these proposed changes we were interested in both current practice with caudal anaesthesia and future plans to adapt practice to meet this guidance.

Strategy for change

A survey was created and sent out using the Scottish Paediatric Anaesthetic Network (SPAN) and the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) mailing lists.

Measure of improvement and Lessons Learnt

There was a total of 204 responses, majority from consultants (89%). 75% currently working in tertiary paediatric hospitals or hospitals which offer specialist paediatric surgery. 76% regularly use regional techniques in their practice. Currently there is a wide variety of equipment used for caudal anaesthesia as shown in fig1 with the majority (71%) using peripheral IV cannula. Only 7% of respondents are currently using NRfit equipment for caudal anaesthesia.

Message for others

This survey has highlighted an issue with a recommended switch to NRfit for regional procedures. There appears to be a lack of NRfit equipment deemed suitable for single shot caudal anaesthesia, and concern amongst professionals over the risk/benefit profile of switching from a technique with a recognised high success rate and low complication profile.


1-               Campbell M.F. Caudal anesthesia in children. J Urol 1933; 30: 245-250

2-               Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg. 1989 Feb;68(2):83-9. PMID: 2913854.

3-               https://www.england.nhs.uk/wp-content/uploads/2019/12/Patient_Safety_Alert_-_resources_to_support_transition_to_NRFit_Aug_2017v2.pdf

4-               https://rcoa.ac.uk/news/transition-non-luer-nrfit-devices

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