Caudal anesthesia

The caudal ( Kaudalblockade , caudal epidural anesthesia ) is a beginning of the 20th century by guided regional anesthesia procedures. An injection is made into the vertebral canal in the sacrum . Caudal anesthesia is a special form of epidural anesthesia that is mainly performed on children, because in these children the spinal cord and dural sac extend further down. The procedure is also used in veterinary medicine, especially in the context of obstetrics .

execution

During the caudal block, the sacral hiatus of the sacrum is punctured , possibly under sonographic control , usually under sedation or after induction of anesthesia, and a long-acting local anesthetic ( ropivacaine , bupivacaine ) is injected into the epidural space of the spinal canal . This is distributed upwards to the adjacent structures of the lower lumbar spine and has a pain-relieving effect there.

In animals, a local anesthetic is injected into the intervertebral space between the sacrum and the first caudal vertebra or between the first and second caudal vertebra without imaging control .

application areas

In children, the caudal block can be used for regional anesthesia for surgical interventions below the navel . Typical indications are corrections of hypospadias , inguinal hernias , orchidopexy or clubfoot correction . It is usually used in combination with general anesthesia ( combination anesthesia ), since the system is often not tolerated in the awake child. Usually a single-shot injection is performed without inserting a catheter. The younger the child, the shorter the postoperative duration of action. Use in adults is the exception, as the puncture is usually difficult.

In animals, the procedure is mainly used for difficult births in the context of obstetrics.

Side effects

Caudal anesthesia is a safe procedure and side effects are rare. An overdose of the medication is possible, which can cause circulatory fluctuations, impaired consciousness and seizures. Incorrect needle positions in vessels or in the liquor space are possible, which can trigger total spinal anesthesia . These incorrect positions are largely eliminated by aspiration with the syringe and the injection of a small test dose. Nerve damage at the injection site has not yet been described in the specialist literature despite its widespread use.

literature

• A. Reich: Regional anesthesia procedures close to the spinal cord in children - caudal block and spinal anesthesia. Anästhesiol Intensivmed Emergency Med Schmerzther 2006; 41: 542-548 PMID 16972203 .
• M. Jöhr: Pediatric anesthesia. P. 168ff. Urban & Fischer Verlag; 7th edition 2008. ISBN 978-3437228315 .

Individual evidence

1. ^ Jean-Athanase Sicard: Les injections médicamenteuses extradurales par voie sacrococcygienne. In: Comptes rendus hebdomadaires des séances et mémoires de la Société de biologie. Volume 53, (April 20) 1901, pp. 396-398.

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