Historically, caudal anesthesia was the first method of epidural anesthesia, and it was she who for decades was called simply “epidural anesthesia” {see epigraph). Then it (not to be confused with intervertebral) was called sacral (through hiatus sacralis), now (not to be confused with trans-sacral and intervertebral sacral) called the caudal — about the tailbone, the human “tail”.
But later she was gradually ousted from the practice of spinal and interverte epidural anesthesia. The reason was a number of deficiencies in caudal anesthesia, especially for adult patients. However, not all of these disadvantages concern small children. In addition, caudal access has some advantages.
Infectiousness of the skin over the sacral opening – more than on the back.
Technical difficulties, due to the inconstancy of the anatomy of the sacral foramen, especially in adults (at least 5% of failures).
The unpredictability of the level of anesthesia, due to the inconstancy of the anatomy and the volume of the sacral canal, especially in adults.
The need for a fairly large amount of local anesthetic for reliable filling of the sacral canal, and because of this – the risk of intoxication.
For the lumbar root block, an even greater amount of local anesthetic is needed, while insufficient relaxation and visceral innervation for abdominal operations.
Hypotension and risk of intoxication with high levels of anesthesia.
Slower (compared to intervertebral access) at the beginning of anesthesia.
The possibility of inadvertent puncture of the dura mater of the spinal cord (as with intervertebral access).
A complete unit of the external arbitrary (of striated muscles) anal sphincter, which is not desirable in some operations.
ADVANTAGES
1. Ideal relaxation and analgesia of the perineum, especially the perinal region, due to the blockade in the first place of sacral cavities.
2. At low levels of the block — lack of significant arterial hypotension.
3. Under the same conditions (as in paragraph 2) – the possibility of outpatient use.
4. The ease of the catheter (you can use a single intravenous cannula) in the sacral canal for long-term intra- and postoperative pain management.
INDICATIONS
It is an ideal method for perineal and perianal operations, such as hemorrhoidectomy or cauterization of rectal tumors. MFMulroy 1996; p.123
! Perineal surgery, especially proctologic, is due to a particularly deep block of sacral roots.
2. Plastic gynecological surgery.
3. Pain relief of childbirth (especially the second period) when it is impossible
intervertebral epidural analgesia (for example, after spinal fusion with metal plates at the lumbar level along the spine), as well as the imposition of obstetric forceps, episiotomy and suturing of the episiotomic wound.
4. In infants and young children, intra- and postoperative analgesia of the lower extremities.
5. Medical blockade (including ambulatory) with ischialgia.
CONTRAINDICATIONS
The same as for intervertebral access (see the section “CONTRAINDICATION OF THE PENASON FOR EPIDURAL ANESTHESIA”), plus coccyx cyst (epithelial tail bone).