Chapter

Sacral epidural (caudal) block

Edward Doyle and Jon McCormack

in Principles and Practice of Regional Anaesthesia

Fourth edition

Published on behalf of Oxford University Press

Published in print November 2012 | ISBN: 9780199586691
Published online November 2012 | e-ISBN: 9780191755507 | DOI: http://dx.doi.org/10.1093/med/9780199586691.003.0015

Series: Oxford Textbooks in Anaesthesia

Sacral epidural (caudal) block

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The sacral approach to the epidural space provides a reliable and effective block for operations which involve low lumbar and sacral dermatomes. The technique of using a single injection of local anaesthetic via the caudal approach combines the advantages of simplicity with a high success rate and a low incidence of side effects. It can be combined with general anaesthesia to reduce the requirement for anaesthetic agent and systemic opioid, allowing rapid pain-free recovery with minimal postoperative vomiting and an early resumption of oral intake. Over 50,000 such blocks are performed annually in the UK (Cook et al. 2008), with satisfactory analgesia being achieved in 95–97% of them (Mercan et al. 2009). The benefits are multifaceted, the technique producing better patient satisfaction and less analgesic requirement than infiltration of local anaesthetic solution for surgery (Siddiqui et al. 2007), and being as effective as lumbar epidural block for total hip arthroplasty (Kita et al. 2007). Caudal analgesia also has a place in the management of chronic pain, with evidence accumulating to support the injection of caudal steroids for low back pain (Conn et al. 2009). Success depends upon accurate localization of the sacral hiatus for access to the sacral epidural space, but there are considerable anatomical differences in its size and shape. These variations may make identification difficult and needle insertion impossible in some cases.

Chapter.  3205 words.  Illustrated.

Subjects: Anaesthetics ; Clinical Skills ; Anatomy

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