Spinal block: Infant vs. adult

Compared to adults, pediatric patients have very little hemodynamic derangement with spinal anesthetics. This holds true for children from the neonatal period through around age 5 (Lopez, 2012). Position of the dural sac varies in children and adults. It is generally believed that the dural sac extends more caudally in children (S3) than its final adult position (S1). Pediatric patients in this age range receiving a spinal anesthetic tend to require larger doses of local anesthetic and its effects are less prolonged. From age six onward children can exhibit signs of a sympathectomy similar to that of adults, with older children (teenagers) having cardiovascular responses almost identical to that of adults (Dalen, 2010). Children ages 10-18 have a PDPH incidence from 10-50%. Below this age group PDPH is thought to be rare (Ross, 2011).