Caudal anaesthesia

Caudal Anaesthesia

Caudal block procedure

Caudal anaesthesia is a type of regional anaesthesia that involves the injection of a local anaesthetic into the caudal epidural space of the sacral canal. This technique is commonly used in pediatric surgery and for procedures involving the lower abdomen, pelvis, and lower limbs. It is a form of epidural anaesthesia and is particularly useful in children due to the ease of access to the caudal space and the predictable spread of the anaesthetic.

Anatomy and Technique

The caudal epidural space is located at the base of the spine, within the sacral canal. The sacral canal is a continuation of the vertebral canal and ends at the sacral hiatus, which is the site of needle insertion for caudal anaesthesia. The sacral hiatus is a bony defect at the lower end of the sacrum, bordered by the sacral cornua.

To perform a caudal block, the patient is typically positioned in the lateral decubitus or prone position. The sacral hiatus is identified by palpating the sacral cornua. A needle is then inserted through the sacral hiatus into the caudal epidural space. Once the needle is in place, a local anaesthetic is injected, which diffuses to block the sacral nerves and lower lumbar nerves.

Indications

Caudal anaesthesia is indicated for a variety of surgical procedures, particularly in pediatric patients. Common indications include:

• Inguinal hernia repair
• Circumcision
• Hypospadias repair
• Anorectal surgery
• Orthopedic surgery of the lower limbs

Advantages

Caudal anaesthesia offers several advantages, especially in children:

• It provides effective pain relief with minimal systemic effects.
• It reduces the need for general anaesthesia and opioids, minimizing postoperative nausea and vomiting.
• It is relatively easy to perform with a high success rate in pediatric patients.

Complications

While generally safe, caudal anaesthesia can be associated with complications, including:

• Infection at the injection site
• Bleeding or hematoma formation
• Dural puncture leading to post-dural puncture headache
• Nerve damage
• Local anaesthetic systemic toxicity

Related Pages

• Epidural anaesthesia
• Spinal anaesthesia
• Regional anaesthesia
• Local anaesthetic