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By H. Renck, A. Johansson, P. Aspelin, H. Jacobsen (auth.), Jack W. Van Kleef Md, Anton G. L. Burm Msc, Johan Spierdijk Md (eds.)

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1971. Long term peridural anesthesia after operations on the organs of the chest in children. Grudnaja Chirurija 13:104 9. , Rodrigues P, Wilsmann 1. 1974. Regionalanaesthesie der oberen ExtremitMt bei Kindern. Anaesthesist 32:178 10. W. 1977. Spread of extradural analgesia following caudal inj ection in children: A statistical study. Brit. J. Anaesth. 49:1027 11. , Schulte-Steinberg O. 1983 in press. Epiduralanaesthesie bei Kindern und ~lteren Patienten Springer-Verlag Berlin Heidelberg New York Tokyo 12.

Fig. 3 shows the plastic sheath in place and the catheter being measured prior to its introduction. Fig. 3 Continuous caudal epidural blockade in the child. The plastic sheath is inserted into the caudal canal. After palpatory orientation of the iliac crests the catheter is measured for length. Fig. 4 after this. The catheter can be advanced with great ease as far as the upper lumbar vertebrae. It is now used as an ordinary lumbar epidural anaesthetic, only that the catheter originates from the sacral hiatus.

For the first attempt to relieve cancer pain, the classic approach is selected for both the diagnostic and the therapeutic block (Figure 5, 6). But if the transcrural approach is chosen, then only a single needle is placed on the right side (Figure 7A) because a needle placed on the left usually will pass through the aorta (Figure 6A, 8A). In the few instances where the cancer pain is not completely relieved within 24 to 48 hours using the classic approach, the block is repeated. Then the combined approach is used.

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