Why is the caudal opening of the spinal canal present?
Failure of the 5th pair of laminae to meet
where do the 5th spinal nerves emerge?
through the hiatus medial to the sacral cornua
where can the epidural venous plexus be found inside the sacral canal?
they are located in the anterolateral portion all the way until S4
Why is there a decrease in predictability of level of anesthesia with caudal approach with increasing age?
the opening of the sacral hiatus may be closed, but most importantly there is a decrease in the amount of adipose tissue found in the sacral hiatus
what are the 3 basic steps to performing a caudal epidural block?
palpitation, identification, and puncture
what position are adults placed in for caudal?
placed primarily in the prone position
what position are peds placed in for caudal?
placed in lateral decubitus position
what is a caudal block useful?
for chronic pain in adults. surgeries involving the sacral segment, ie clubfoot repair, circ, hypospadias repair, or rectal surgery
Is there more of a sensory, motor, or combined anesthesia?
there is more of a sensory blockade
what size needle is used for caudual block
2.5cm long, 23g
what is the insertion, penetration, and advancement technique for caudal block
Insert the needle midline at 60 degree angle to the coronal plane. Penetration of the sacrococcygeal membrane is acheived with a loss of resistance (pop). Needle is lowere to 20 degree angle and advanced 2-3mm to make sure that bevel is in the caudal space
where is the dura usually located in the sacrum?
around the level of S2,
what dose of anesthetic is appropriate for sacral blockade in peds?
Bupivacaine 0.25% 0.5ml/kg