Neuropathic pain and foot drop related to nerve injury after short duration surgery and caudal analgesia

Caudal anesthesia is the most common type of regional anesthetic technique performed in children. The incidence of neurologic adverse events is extremely rare. A postoperative complication of a mild but permanent neurologic deficit after administration of a caudal anesthetic in a previously well 9-year-old boy who required emergency scrotal exploration for a testicular torsion is reported. The caudal injection provided good postoperative analgesia, which probably resulted in the patient remaining in the same position overnight. This may have contributed to the development of the neurologic deficit, probably owing to a compressive neuropathy. We suggest that, as anesthesiologists obtaining informed consent for anesthetic interventions, we now need to inform guardians/carers of pediatric patients who are to receive caudal analgesia of the extremely small material risk of neurologic damage after caudal anesthesia. Additionally, the anesthetic community may need to consider revising postoperative care instructions to prevent the future occurrence of this rare outcome, particularly if using additives that prolong analgesic block duration.