Sacral intervertebral epidural blockade, with the introduction of the needle between the sacral vertebrae, is possible only in children who have not yet grown these vertebrae. It represents the al ternative of caudal anesthesia, when sacral horns cannot be felt because of the unusual structure of the sacrum or excessive amount of fat. It should not be confused with the caudal blockade (in which the needle is inserted through hiatus sacralis) and trans-sacral (in which the needle is inserted).
Advantages: technical ease and less risk of infection (further from the anus!), Especially when the need for the introduction of a catheter.
The anatomy of the children’s sacrum is distinguished by the fact that the sacral vertebrae have not yet grown together and resemble the lumbar, that is, the bodies of the vertebras are still divided by intervertebral disks, and the arms are yellow ligaments; Sacral vertebrae fusion begins caudally (between S4 and 55) at about 18 years of age, continuing in the cranial direction and ending at the age of 25-30 years.
The technique of the blockade according to Busoni and Sarti consists in the epidural puncture between S2 and S3, since this gap is the widest and easiest to identify and, moreover, is ossified rather late. The pose is lateral with bent legs (all punctures were performed by the authors of the technique under masked ftorotan-soured anesthesia, under which venous access was primarily provided). The landmark is the line between spinae iliacae posteriores superiores (they are easily palpated and often seen in children), 0.5 – I cm caudal to this line, the interval between vertebral arches S2 and S3 is determined by palpation .
The authors of the method used it in 74 children aged 2 months to 13 years, in 1! of these children, caudal anesthesia could not be performed because it was impossible to grope sacral lobes due to impaired anatomy or a large amount of adipose tissue.
Before the epidural puncture, the skin was punctured with a thick needle to avoid the epidural needle to insert a piece of skin into the epidural space. For single anesthesia, the puncture was performed with a Crawford needle (with a normal cut) of the G19 caliber , and Tui needles of the GI9 caliber were used for anesthesia for more than half an hour , with further catheterization of the epidural space, which was identified by a syringe test for loss of resistance, although it felt good failure “during the passage of the needle through the yellow ligament. The depth of insertion of the needle, depending on the age and amount of adipose tissue, ranged from 8 to 30 mm.