Reply to Haydar, Bishr; Holman, Ashlee; Galante, Dario, regarding their comment ‘ESPA Pain Management Ladder: Caudal Clonidine and Cost/Benefit Considerations

^Abstract

we thank Dr Haydar and colleagues for their comments on our article and we appreciate their interest and expertise in this field. We note their support for the concept of providing a framework for improvement in care. They make specific points about caudal epidural clonidine, outcomes, risk‐benefit balance, use of ultrasound guidance, and the possibility that pain assessment has caused overuse of opioids. We feel that they may have misunderstood some aspects of the nature and purpose of the ESPA Pain Management Ladder initiative and also have extrapolated unreasonably from experiences in adult practice and problems in the USA with inappropriate use of opioids.

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