Analysis of caudal epidurogram in single center: A preliminary study of lumbar radiculopathy management.

A caudal epidural block involves placing a needle through the sacral hiatus and delivering medication into the epidural space. The procedure is safe and simple, but failure rates can be as high as 25%. The purpose of this study was to investigate the success rate of caudal epidural block by analyzing needle placement and dye flow pattern.We retrospectively analyzed the medical records of patients who underwent caudal epidural block under spinal stenosis. A case was defined as a failure if it met at least one of the following four criteria: the epidural needle was not placed correctly inside the caudal canal; blood regurgitation or aspiration in the needle was observed; the contrast dye was injected into a blood vessel; or a large amount of the dye leaked into the sacral foramen or did not reach the L5-S1 level.At least 1 failure criterion was observed in 14 cases (17.7%), while none of the failure criteria were satisfied in 65 successful cases (82.3%).No matter how experienced the anesthesiologist may be, delivery of adequate therapeutic agent is not achieved in approximately 20% of cases. Therefore, we recommend fluoroscopy-guided needle placement and confirmation by radio-contrast epidurograpy as the best choice.

Systematic review of caudal epidural injections in the management of chronic back pain.

Epidural steroids recently attracted world attention due to medication contamination resulting in many cases of fungal meningitis. What was rarely noted in these reports is that there is little data to support use of this treatment. This article reviews the literature on epidural steroids for various types of back pain and concludes that further testing should be performed to determine if and in what situations this intervention is useful before wide-spread use is resumed.

A survey of aseptic precautions and needle type for paediatric caudal block in Australia and New Zealand.

This cross-sectional survey was designed to evaluate the current practice of anaesthetists in Australia and New Zealand with regard to aseptic technique and needle type during the performance of single-shot caudal blocks. Professional bodies suggest that full aseptic precautions be taken during the administration of caudal or epidural blocks. It has been suggested that using an intravenous cannula or a styletted needle may obviate the occurrence of epidermoid tumours. A total of 202 members of the Society for Paediatric Anaesthesia in New Zealand and Australia were invited to participate in this internet-based survey. Eighty-four responses were received. Most respondents used some form of antiseptic handwash (81%), wore sterile gloves (85.7%), used antiseptic skin preparation (100%) and draped the site (57.1%). When performing caudal blocks, 43.1% used unstyletted needles, 27.2% used styletted spinal needles and 29.6% used intravenous cannulas. However, 11.9% did not wash hands, 10.7% did not wear gloves and 42.9% did not drape the site. Three respondents reported neither handwashing, wearing gloves or draping, instead only using an alcohol swab for skin preparation. The majority of respondents in our region appear to use some level of aseptic precautions, albeit to a variable degree. Published recommendations may either be perceived as overly cautious or as ambiguous in that they do not specify caudal practice as distinct from other epidural blocks. There is a need for clearer professional guidance to support a minimum level of aseptic precaution for single-shot caudal epidural blocks.

Morphometry of sacral hiatus and its clinical relevance in caudal epidural block.

BACKGROUND: Sacral approach to epidural space produces reliable and effective block of sacral nerves. It is necessary to have a detailed knowledge of sacral hiatus (SH) for optimal access into sacral epidural space. This study was undertaken to evaluate various landmarks of SH. METHODS: One hundred and fourteen adult dry human sacral bones were examined for morphometric analysis using vernier caliper. SH was categorized on the basis of shape. RESULTS: Most commonly encountered shape of hiatus was inverted U (40.35%). Its apex and base were most commonly observed against fourth and fifth sacral vertebrae, respectively. Various defects in dorsal wall of sacral canal were recorded. Height and anteroposterior depth at the apex of hiatus were ranged 4.30-38.60 and 1.90-10.40 mm, respectively. Mean intercornual distance at base was 11.95 +/- 2.78 mm. The triangle formed by right and left posterior superior iliac spines and apex of SH was found equilateral in 45% cases only. Sacral cornua were marked by their bilateral presence in 55.26% and impalpable in 21.05% cases. Minimum distance between S2 and apex was 7.25 mm which suggested that it would not be safe to push the needle beyond 7 mm into sacral canal so as to avoid dural puncture. In 8.77% cases, depth of hiatus was less than 3 mm. CONCLUSIONS: Single bony landmark may not help in locating SH because of anatomical variations. Depth of hiatus less than 3 mm may be one of the causes for failure of needle insertion. Surrounding bony irregularities, different shapes of hiatus and defects in dorsal wall of sacral canal should be taken into consideration before undertaking caudal epidural block so as to avoid its failure.

Anestesia caudal para cirugía pediátrica

El objetivo de este análisis es el de resaltar las grandes ventajas del Bloqueo Peridural Caudal (BPDC) solo o combinado para cirugía desde abdomen superior hasta extremidades, dar a conocer los excelentes resultados, desmitificar la técnica y sembrar la inquietud para su utilización. Se verificaron 1083 pacientes para cirugías programadas y de urgencia; a los que se les realizaron 1572 procedimientos. El 65.3 por ciento fueron ASA I y 0.74 por ciento ASA IV. La edad varió de 1 día hasta los 12 años de vida; el sexo 70.64 por ciento masculino; y el peso de 1.5 a 50 Kgs. La monitoría incluyó fonendoscopio precordial, cardioscopio, pulso-oxímetro y tensiómetro. Las agujas utilizadas fueron pericraneal 21-23, catéter de teflón 20-22 o Tuohy 18. La punción caudal se verifica con el paciente en posición prona con un rollo debajo de la pelvis y el menor de los caso en posición lateral. Se empleó en todos los casos Bupivacaína a 1.6 ml/kg de volumen y a 4 mg/kg. El BPDC como técnica única en el 85.5 por ciento, y combinado en el 14.5 por ciento fue requerido generalmente para cirugías en posición diferente a la supina, pacientes en mal estado general, o con manipulación visceral alta. En el 21.5 por ciento se dejó catéter intraoperatorio para manejo de dosis múltiples, y en el 9.14 por ciento se dejó para manejo de dolor post-quirúrgico. Complicaciones mínimas, desde fallas en el bloqueo o insuficiente hasta sólo 1 caso de paro cardiorrespiratorio por BPDC alto que se resolvió rápidamente sin dejar secuelas. Recomendamos el uso de esta técnica por ser fácil de realizar, proporciona gran estabilidad hemodinámica, analgesia post-quirúrgica duradera, pronto inicio de la vía oral y reducción de costos

Caudal bupivacaine for postoperative analgesia in pediatric lower limb surgery.

One hundred children aged 1 to 15 years were randomly allocated to two equal groups. All underwent cold orthopedic surgery to the lower limb, of more than 1 hour's duration with a standard anesthetic technique. One group received caudal bupivacaine 0.25%, 0.7 mL/kg, and one group acted as controls. There were no cases of fecal incontinence in the theater complex but urinary incontinence in the immediate recovery phase increased from 14% in the control group to 34% in the caudal group (P < .05). The caudal block had a duration of effect lasting 5 to 6 hours, and provided better recovery room analgesia (P < .01). The advantages for the child are discussed.