ABSTRACT
Rectal tenesmus is a very uncomfortable symptom. Though antiarrhythmic drugs and nerve blocks have been proposed as a treatment for rectal tenesmus, none is well-established. We report a 68-year-old female who undertook surgery for uterine cervical cancer and underwent chemotherapy. She got a bilateral nephrostomy and bowel obstruction during the chemotherapy because of recurrence. She decided to stop chemotherapy and to receive palliative care. She had a symptom of rectal tenesmus, which was refractory to medications. The clinical sign was severe and uncomfortable, making her very nervous. We planned to treat the rectal tenesmus with a nerve block. A ganglion impar block was insufficient to remove the symptom, and the saddle block failed due to epidural lipomatosis. We finally succeeded in alleviating the sign with a neurolytic caudal epidural block. Relief of tenesmus made her hope to spend her final period at home. She could stay at home with her family for seven days before death without recurrence of the symptom. Though there is no report about the effectiveness of neurolytic caudal epidural block for rectal tenesmus, we consider the block appropriate for the symptom.
ABSTRACT
Introduction: Sacral hiatus (SH) is a significant landmark during caudal epidural block (CEB) which is employedfor analgesia and anaesthesia during a wide range of clinical conditions. This requires a thorough knowledge ofmorphometric characteristics of SH and surrounding landmarks, but variability in morphometric dimensionsexists among different populations.Aim: The aim of this study was to identify different anatomical landmarks to detect the location of SH andprovide a reference database for morphometric dimensions of SH in Indian population.Materials and Methods: The study was done on 108 dry adult human sacra. Linear measurements of the sacrawere taken with the help of digital vernier caliper and angular parameters were determined with a goniometer.Results: The most common shape of the sacral hiatus was inverted ’V’ shaped (59.3%) with the level of the apexat S4 in 66.7% and base at S5 in 86.1% cases. Morphometric dimensions of SH were found to be smaller in presentstudy as compared to reports by other researchers. Left crest-apex angle was observed to be significantly greaterthan the right crest-apex angle. (p 0.001).Conclusion: Multiple bony landmarks and their morphometric dimensions should be considered to locate the SHduring CEB. Values for various morphometric parameters of SH are less in Indians in comparison to otherpopulations, which should be contemplated during caudal epidural injections and trans-sacral thecaloscopy.
ABSTRACT
Background & objectives: The opening at the inferior end of sacral canal is known as sacral hiatus.It formed due to the failure of fusion of laminae of the fifth (occasionally fourth) sacral vertebra. Sacrum is one of the bones which exhibit variations and the variation of sacral hiatus is of great clinical significance. Present study determined the landmarks for caudal epidural block (CEB) after morphometric measurements of the sacral hiatus on dry sacra bones .Methods: 120 sacral bones are used for the study. Anatomical measurements were measured by using Vernier caliper accuracy to 0.1mm. Results: Agenesis of sacral hiatus was detected in two sacral bones. Various shapes of sacral hiatus were observed which included inverted U (31%), inverted V (25.8%), irregular (20.6%), Elongated (17.2%) and dumbbell (5%). Apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 50.8%. The distance between the two superolateral sacral crests and the distance between the apex of sacral hiatus and the right and left super lateral crests were 69.5 (5.8) mm, 61.4 (11.2) mm, 57.4 (9.7) mm respectively, on average. The mean, mode, SD is calculated for all the measurements. Interpretation & conclusion: The sacral hiatus has anatomic variations. Understanding of these variations may improve the reliability of, caudal epidural block (CEB). [Satish P NJIRM 2016; 7(5):69-72]
ABSTRACT
Background: Sacrum is formed by the fusion of five sacral vertebrae and forms the lower part of Vertebral column. The opening present at the lower end of sacral canal is known as sacral hiatus. Methods: This study was carried out on 75 dry human sacra of unknown sex to study the variations of sacral hiatus. Various shapes of sacral hiatus were observed which included inverted u, inverted v, irregular, dumbbell and bifid. The apex of sacral hiatus was commonly found at the level of 4th sacral vertebra. The mean length of sacral hiatus, the mean anteroposterior diameter of sacral canal was measured. The narrowing of sacral canal at the apex of sacral hiatus was measured. Results: We observed length of Sacral hiatus from apex to midpoint of base – maximum length was found to be 11 – 20 mm in 32 dry sacra. Anteroposterior diameter at the sacral hiatus was found to be 0 – 3 mm. in 35 dry sacra. Base (Transverse diameter) was found to be 11 – 15 mm in 36 dry sacra. Median distance between the level of lower margin of S2 and apex of sacral hiatus was 21 – 30 mm in 25(33%) Sacra. Distance between midpoint of Base to S2 foramen was found to be >40 mm in 52 Sacra and that accounts for 69 %. Conclusion: The knowledge of anatomical variations of sacral hiatus is clinically important for caudal epidural block in Pediatric, Obstetric, Orthopedic, Urologic and Surgical practice. The reliability and success of caudal epidural block depends upon Knowledge of Variations of Sacral hiatus.
ABSTRACT
Successful caudal epidural block (CEB) for various gynaecological and orthopaedic procedures requires an elaborate knowledge of anatomical profile of sacral hiatus. Varied morphology of sacral hiatus is likely to influence the success rate of CEB. Scanty literature is available on the morphometry of sacral hiatus in North Indian subjects. Therefore, sacral hiatus of 60 North Indian human sacra were evaluated using Vernier calipers. Sexing of the sacra was done by calculating the sacral index. Following parameters of sacral hiatus were observed and recorded: a) Shape, b) Level of apex, c) Maximum distance between the sacral cornua, d) Length of the sacral hiatus i.e. from its apex to midpoint of its base, e) Antero-Posterior diameter at the apex of sacral hiatus. The data obtained was analyzed using SPSS software (version 18). Various shapes of sacral hiatus were observed. It was irregularly shaped in both the sexes though inverted U shaped sacral hiatus was also seen frequently in females. In males, the apex of sacral hiatus was commonly seen at the level of spinous process of 3rd sacral vertebra in males and below the level of spinous process of 4th sacral vertebra in females. The mean distance between the sacral cornua was 1.1cm : 1.2cm in males and females, respectively. Mean length of the sacral hiatus was 2cm in both sexes. Antero-posterior depth at the apex the sacral hiatus was 6mm in both the genders. The dimensions of sacral hiatus obtained in this study were inconsistent with earlier studies. Knowledge of these dimensions may help the clinicians in precisely locating sacral hiatus for successful CEB in North Indians.
Subject(s)
Varicose VeinsABSTRACT
Sacrum is formed by the fusion of five sacral vertebrae and forms the lower part of vertebral column. The opening present at the lower end of sacral canal is known as sacral hiatus. Anatomical variations in morphology and morphometry of sacral hiatus are important clinically as well as surgically. 159 dry clean human Sacra were taken from Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research Vallah (Amritsar). Various shapes of sacral hiatus were observed which included inverted U (42.95%), inverted V (27.51%), irregular (16.10%), dumbbell (11.40%) and bifid (2.01%). The apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 56.36%. The mean length of sacral hiatus was 22.69 mm. The mean anteroposterior diameter of sacral canal at the apex of sacral hiatus was 6.49 mm. Narrowing of sacral canal at the apex of sacral hiatus (diameter less than 3 mm) was observed to be high (5.36%). The knowledge of anatomical variations of dimensions of sacral hiatus is important while doing caudal epidural block and it may help to improve its success rate.
El sacro está conformado por la fusión de las cinco vértebras sacras, y forma la parte inferior de la columna vertebral. La abertura presente en el extremo inferior del canal sacro se conoce como hiato sacro. Las variaciones anatómicas en la morfología y la morfometría del hiato sacro son importantes clínica y quirúrgicamente. Fueron utilizados 159 sacros humanos, limpios y secos, del Departamento de Anatomía, Sri Guru Ram Das Instituto de Ciencias Médicas e Investigación Vallah (Amritsar). Fueron observadas varias formas de hiato sacro: U invertida (42,95%), V invertida (27,51%), irregular (16,10%), de pesa (11,40%) y bífida (2,01%). El ápice del hiato sacro se encuentra comúnmente a nivel de la cuarta vértebra sacra en el 56,36%. La longitud media de hiato sacro fue 22,69 mm. El diámetro medio anteroposterior del canal sacro en el ápice del hiato sacro fue 6,49 mm. El estrechamiento del canal sacro en el ápice del hiato sacro (diámetro inferior a 3 mm) fue alto (5,36%). El conocimiento de las variaciones anatómicas de las dimensiones del hiato sacro es importante para el bloqueo epidural caudal y puede ayudar a mejorar su tasa de éxito.
Subject(s)
Humans , Sacrum/anatomy & histology , Anatomic Variation , Spine , IndiaABSTRACT
Air injected into the epidural space may spread along the nerves of the paravertebral space. Depending on the location of the air, neurologic complications such as multiradicular syndrome, lumbar root compression, and even paraplegia may occur. However, cases of motor weakness caused by air bubbles after caudal epidural injection are rare. A 44-year-old female patient received a caudal epidural injection after an air-acceptance test. Four hours later, she complained of motor weakness in the right lower extremity and numbness of the S1 dermatome. Magnetic resonance imaging showed no anomalies other than an air bubble measuring 13 mm in length and 0.337 ml in volume positioned near the right S1 root. Her symptoms completely regressed within 48 hours.
Subject(s)
Female , Humans , Epidural Space , Hypesthesia , Injections, Epidural , Lower Extremity , Magnetic Resonance Imaging , ParaplegiaABSTRACT
STUDY DESIGN: A prospective study. OBJECTIVES: To evaluate the effectiveness of ultrasound guidance in caudal epidural block and sonographic feature of sacral hiatus. SUMMARY OF LITERATURE REVIEW: High success rate of ultrasound-guided regional nerve block has been reported and recently, ultrasound-guided nerve block in spinal field has been introduced. MATERIALS AND METHODS: Ultrasound-guided caudal epidural block was performed in 48 patients with radiating pain to leg. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. After measuring the intercornual distance, thickness of sacrococcygeal membrane and depth of sacral canal in transverse view, then the probe was rotated 90degrees to obtain the longitudinal view of the sacral hiatus. Under ultrasound guidance, a 21-gauge needle was inserted into the sacral hiatus in parallel with sacrum base. After contrast dye injection, needle placement was checked by the fluoroscopy and then medication was injected into the caudal epidural space. We investigated the change of radiating pain after caudal epidural block using visual analogue scale(VAS). RESULTS: The intercornual distance was mean 16.4+/-2.3mm, thickness of sacrococcygeal membrane was mean 2.8+/-0.9mm and depth of sacral hiatus was mean 2.6+/-0.9mm. There was 97.9% success rate of the caudal epidural block under ultrasound guidance. The mean VAS for radiating pain was improved from 7.5+/-0.7 before the block to 2.8+/-1.5 after the block. CONCLUSIONS: Ultrasound-guided caudal epidural block seems to provide good anatomical landmark of sacral hiatus and an effective tool with high success.