To the Editor:—

In the December 2001 issue of Anesthesiology, Dr. Sciard et al.  1describe continuous lumbar plexus blocks performed in two pediatric patients, aged 4 yr and 16 months. They state, “The absence of epidural spread was assessed by hemodynamic stability after the performance of the blocks.” Hemodynamic stability should not be used to exclude an epidural block since infants and children up to approximately 5 yr of age show little or no change in blood pressure following central neuraxial blockade, even dense spinal blockade to high thoracic levels. 2,3 

Sciard D, Matuszczak M, Gebhard R, Greger J, Al-Samsam T, Chelly JE: Continuous posterior lumbar plexus block for acute postoperative pain control in young children. A nesthesiology 2001; 95: 1521–3
Dohi S, Naito H, Takahashi T: Age-related changes in blood pressure and duration of motor block in spinal anesthesia. A nesthesiology 1979; 50: 319–23
Oberlander TF, Berde CB, Lam KH, Rappaport LA, Saul JP: Infants tolerate spinal anesthesia with minimal overall autonomic changes: Analysis of heart rate variability in former premature infants undergoing hernia repair. Anesth Analg 1995; 80: 20–7