RT Book, Section
A1 Candido, Kenneth D.
A1 Winnie, Alon P.
A2 Hadzic, Admir
SR Print(0)
ID 3499818
T1 Chapter 15. Caudal Anesthesia
T2 NYSORA Textbook of Regional Anesthesia and Acute Pain Management
YR 2007
FD 2007
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071449069
LK accessanesthesiology.mhmedical.com/content.aspx?aid=3499818
RD 2024/04/24
AB Caudal  anesthesia  was  first  described  at  the  turn  of  last  century  by  two  French  physicians,  Fernand  Cathelin  and  Jean-Athanase  Sicard.  The  technique  predated  the  lumbar  approach  to  epidural  block  by  several  years.1  Caudal  anesthesia,  however,  did  not  gain  in  popularity  immediately  following  its  inception.  One  of  the  major  reasons  caudal  anesthesia  was  not  embraced  arose  from  the  wide  variety  of  arrangements  of  sacral  bones  encountered  in  the  general  population  and  the  consequent  high  failure  rate  associated  with  attempts  to  locate  the  sacral  hiatus.  The  failure  rate  of  5%  to  10%  made  caudal  epidural  anesthesia  unpopular  until  a  resurgence  of  interest  occurred  in  the  1940s  led  by  Hingson  and  colleagues,  who  used  it  primarily  in  obstetrical  anesthesia.  Caudal  epidural  anesthesia  has  many  applications,  including  surgical  anesthesia  in  children  and  adults,  as  well  as  the  management  of  acute  and  chronic  pain  conditions.  Success  rate  of  98%  to  100%  can  be  achieved  in  infants  and  young  children  before  the  age  of  puberty,  as  well  as  in  lean  adults.1  The  technique  of  caudal  epidural  block  in  pain  management  has  been  greatly  enhanced  by  the  use  of  fluoroscopic  guidance  and  epidurography,  in  which  high  success  rates  can  be  attained.  Unfortunately,  clinical  indications,  and  especially  therapeutic  interventions  for  the  relief  of  chronic  pain  in  individuals  with  failed  back  surgery  syndrome,  are  often  most  prevalent  in  patients  with  difficult  caudal  landmarks.  It  has  been  suggested  that  traditional  lumbar  peridural  block  should  not  be  attempted  employing  an  approach  requiring  needle  placement  through  a  spinal  surgery  scar,  due  to  the  likelihood  of  tearing  the  dura  and  the  possibility  of  inducing  hematoma  formation  over  the  cauda  equina  when  blood  from  the  procedure  gets  trapped  between  the  layers  of  scar  and  connective  tissues.2  Under  these  circumstances,  it  is  recommended  that  fluoroscopically  guided  caudal  epidural  block  be  performed  in  lieu  of  the  traditional  approach.  The  second  resurgence  in  popularity  of  caudal  anesthesia  has  paralleled  the  increasing  need  to  find  safe  alternatives  to  conventional  lumbar  epidural  block  in  selected  patient  populations,  such  as  individuals  with  failed  back  surgery  syndrome.