Describe Caudal Anaesthesia in detail.

Definition

Caudal anaesthesia is a form of epidural anaesthesia performed through the sacral hiatus (an opening at the lower end of the sacrum), depositing local anaesthetic in the caudal (sacral) epidural space. It blocks the sacral and lower lumbar nerve roots.

Uses

It is used especially in children (where the anatomy is easily identified) for analgesia in lower abdominal, perineal, urological and lower-limb surgery (e.g. Circumcision, herniotomy, hypospadias), usually as a single injection under general anaesthesia to provide postoperative pain relief. In adults it is used for some perineal/anorectal procedures and in chronic pain management.

Anatomy & Practical Points

The caudal route relies on identifying the sacral hiatus, the gap left by the unfused laminae of the fifth sacral vertebra, bounded by the sacral cornua, which is readily palpable in children and makes the technique reliable and safe in that group. In adults the hiatus is more variable and sometimes difficult to locate, and the surrounding bony landmarks are less distinct, so the technique is used less often and ultrasound may assist; the volume of local anaesthetic determines how high the block spreads within the sacral and lower lumbar segments, and the block is typically placed as a single injection after induction of general anaesthesia in children.

In Brief

In short, it is the reliable, safe paediatric block placed under anaesthesia for lower-body postoperative pain relief.

Widely used in paediatric sub-umbilical surgery.

• Caudal = epidural through the sacral hiatus into the caudal epidural space; blocks sacral/lower lumbar roots.
• Chiefly in children for lower abdominal, perineal, urological & lower-limb analgesia.
• Usually single-shot under GA for postoperative pain relief.
• Adult uses: perineal/anorectal procedures, chronic pain.