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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 50 – Caudal Block

PERSPECTIVE

Advances in lumbar epidural anesthesia have helped caudal anesthesia become an infrequently utilized and taught technique. Nevertheless, caudal anesthesia can be effectively used for anorectal and perineal procedures, as well as some lower extremity operations.

Patient Selection.

Patient selection for caudal anesthesia should be determined realistically by examining the anatomy of the sacral hiatus. In approximately 5% of adult patients, the sacral hiatus is nearly impossible to cannulate with needle or catheter; therefore in 1 of 20 patients the technique is clinically unusable. Likewise, there are patients in whom the tissue mass overlying the sacrum makes the technique difficult; so if another technique is applicable, caudal anesthesia should be avoided. Probably more so than for any other block, the experience and confidence of the anesthesiologist are necessary to carry out the technique effectively.

Pharmacologic Choice.

When choosing local anesthetics for caudal anesthesia, the same considerations as those applied to epidural anesthesia are needed. It must be recognized that local anesthetic volumes of 25 to 35 mL are necessary to provide a predictable sensory level of T12 to T10 with caudal injection for adults.

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