Use of caudal epidural catheter in a child with cerebral palsy with prior posterior spine (T1-sacrum) fusion

A 15-year-old boy, weighing 35.4 kg with medical history of spastic quadriplegic CP pattern secondary to post-traumatic brain injury, developmental delays, seizure disorder, reactive airway disease and gastroesophageal reflux disease with gastrostomy tube, was scheduled for bilateral femoral osteotomies, right pelvic osteotomy, open reduction of dislocated spastic right hip and right adductor release. To minimise infection risk in the sacral area, the epidural catheter was looped to stay away from the anus and secured in a sterile fashion with transparent sterile dressings to prevent seepage while providing opportunity for daily examination of the catheter insertion site. Epidural local anaesthetic was effective, as evidenced by the minimal fluctuation in heart rate and blood pressure measurements during a surgical duration of 4.1 h. As anticipated, the patient had an estimated blood loss of 1100 mL, for which he received a transfusion of packed red cells and fresh frozen plasma in addition to crystalloids to correct coagulopathy.