Anatomical Differences in Sacral Hiatus During Caudal Epidural Injection with Ultrasonography Guidance and Its' Effect on Success Rate

Abstract Introduction and Materials and Methods: The Study was carried out on 100 dry human sacra to know the Anatomical variations of sacral hiatus. Results: Different shapes of sacral hiatus were observed which included- Inverted U (56%), Inverted V (14%), Irregular (16%), Dumb-bell (10%), Bifid (2%) and Elongated (2%). The apex of the sacral hiatus was most commonly found at the level of 3rd sacral vertebrae in 62%. The mean length of sacral hiatus was 25.2mm, the mean anteroposterior diameter of sacral canal at the apex of sacral hiatus was 5.53mm. The mean distance between sacral cornu at the base of sacral hiatus was observed to be 19.5mm. Conclusion: This study was done to clarify the anatomical variations of sacral hiatus using bony landmarks of sacrum for improving the reliability of caudal epidural anesthesia and to improve its success rate and reduce the complications and failure rate.

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A study of variations of sacral hiatus of dry human sacra in north interior Karnataka region

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401772 ◽

2014 ◽

Vol 03 (04) ◽

pp. 215-219 ◽

Cited By ~ 1

Author(s):

Vijaykumar Shinde ◽

P S Bhusaraddi

Keyword(s):

Spina Bifida ◽

Success Rate ◽

Epidural Anaesthesia ◽

Anatomical Variations ◽

The Other ◽

Caudal Anaesthesia ◽

Anatomical Knowledge ◽

Sacral Hiatus ◽

Caudal Epidural

Abstract Background and aims: The shape of sacral hiatus is known to show a number of anatomical variations. The shape and extent of sacral hiatus is important because in caudal epidural anaesthesia, the approach is made through sacral hiatus. The detailed anatomical knowledge of variations of sacral hiatus is very helpful to the anaesthetists to increase the success rate of caudal anaesthesia. The present study is an attempt to find out variations of sacral hiatus in north interior Karnataka region. Materials and methods: For the present study, one hundred dry human sacra obtained from north interior Karnataka region were used. Results: The inverted U shaped sacral hiatus was most common (56%). Inverted V shaped sacral hiatus was found in 24% of sacra. The other variations like irregular shaped hiatus (10%), bifid hiatus (2%), dumbbell shaped hiatus (5%), complete spina bifida (1%) and absent hiatus (2%) were also found. Conclusion: Abnormal shapes of sacral hiatus like irregular, bifid, dumbbell, completespina bifida and absent hiatus were seen in 20%of total 100 sacra belonging to north interior Karnataka.

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Small Needle Vertical Caudal Epidural Injection Method: Success Rate and Safety Profile

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2015.08.343 ◽

2015 ◽

Vol 96 (10) ◽

pp. e103

Author(s):

Liza Smigel ◽

Kenneth Dean Reeves ◽

Howard Jeffrey Rosen ◽

David Rabago

Keyword(s):

Success Rate ◽

Safety Profile ◽

Epidural Injection ◽

Injection Method ◽

Small Needle ◽

Caudal Epidural

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Anatomic Differences in the Sacral Hiatus During Caudal Epidural Injection Using Ultrasound Guidance

Journal of Ultrasound in Medicine ◽

10.7863/ultra.14.12032 ◽

2015 ◽

Vol 34 (12) ◽

pp. 2143-2148 ◽

Cited By ~ 5

Author(s):

Gi-young Park ◽

Dong Rak Kwon ◽

Hee Kyung Cho

Keyword(s):

Ultrasound Guidance ◽

Epidural Injection ◽

Sacral Hiatus ◽

Caudal Epidural

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Caudal Epidural Block: An Updated Review of Anatomy and Techniques

BioMed Research International ◽

10.1155/2017/9217145 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 24

Author(s):

Sheng-Chin Kao ◽

Chia-Shiang Lin

Keyword(s):

Failure Rate ◽

Epidural Space ◽

Intrathecal Injection ◽

Epidural Injection ◽

Epidural Block ◽

High Failure Rate ◽

Caudal Epidural Block ◽

Sacral Hiatus ◽

Comparative Treatment ◽

Caudal Epidural

Caudal epidural block is a commonly used technique for surgical anesthesia in children and chronic pain management in adults. It is performed by inserting a needle through the sacral hiatus to gain entrance into the sacral epidural space. Using conventional blind technique, the failure rate of caudal epidural block in adults is high even in experienced hands. This high failure rate could be attributed to anatomic variations that make locating sacral hiatus difficult. With the advent of fluoroscopy and ultrasound in guiding needle placement, the success rate of caudal epidural block has been markedly improved. Although fluoroscopy is still considered the gold standard when performing caudal epidural injection, ultrasonography has been demonstrated to be highly effective in accurately guiding the needle entering the caudal epidural space and produce comparative treatment outcome as fluoroscopy. Except intravascular and intrathecal injection, ultrasonography could be as effective as fluoroscopy in preventing complications during caudal epidural injection. The relevant anatomy and techniques in performing the caudal epidural block will be briefly reviewed in this article.

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2102430 An Anatomic Difference of the Sacral Hiatus in Caudal Epidural Injection Using Ultrasound Guidance

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2014.12.660 ◽

2015 ◽

Vol 41 (4) ◽

pp. S173

Author(s):

Gi-Young Park ◽

Hee Kyung Cho

Keyword(s):

Ultrasound Guidance ◽

Epidural Injection ◽

Sacral Hiatus ◽

Caudal Epidural

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Caudal epidural injection of a combination of ketamine and xylazine for perineal analgesia in horses

Veterinary Anaesthesia and Analgesia ◽

10.1046/j.1467-2995.2000.00018-4.x ◽

2000 ◽

Vol 27 (2) ◽

pp. 115 ◽

Cited By ~ 6

Author(s):

A Kariman ◽

I Nowrouzian ◽

J Bakhtiari

Keyword(s):

Epidural Injection ◽

Caudal Epidural

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Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections

10.22541/au.161545792.21587393/v1 ◽

2021 ◽

Author(s):

Rekib Sacaklidir ◽

Ekim Can Ozturk ◽

Savas Sencan ◽

Osman Hakan Gunduz

Keyword(s):

Ionizing Radiation ◽

Imaging Techniques ◽

Epidural Injection ◽

Critical Issue ◽

University Hospital ◽

Epidural Injections ◽

Epidural Steroid Injections ◽

Dose Levels ◽

Interlaminar Epidural Injection ◽

Caudal Epidural

Background: Since fluoroscopy-guided interventional therapies grew significantly in recent years, exposure to ionizing radiation (IR) either for patient or medical staff became a critical issue. IR exposure varies according to the physicians’ experience, patients’ body mass index (BMI), imaging techniques and type of the procedure performed. The purpose of this study is to calculate the reference IR doses for fluoroscopy-guided epidural injections per procedure and BMI to provide reference doses for potential use in future dose reduction strategies. Methods: A retrospectively, evaluation of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center, was performed. This observational study was conducted with patients aged  18 who underwent 3711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal and caudal approaches. Provided IR doses for each patient were also divided by patients’ BMI to obtain dose per BMI. Results: The highest IR dose per procedure was found in caudal epidural injection with 0.218 mGy m2 and lowest dose was in cervical interlaminar epidural injection with 0.057 mGy m2. The IR dose per procedure was 0.123 mGy m2 for lumbar transforaminal and 0.191 mGy m2 for lumbar interlaminar epidural injection. Caudal epidural injection had also the highest IR dose per BMI which was 0.00749 and cervical interlaminar epidural injection had the lowest radiation dose per BMI which was 0.00214. Conclusions: We proposed reference IR dose levels of four approaches of epidural injections obtained from 3711 injections performed in a university hospital pain medicine clinic. BMI of patients were taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels which will guide pain physicians to self-assess their own levels of radiation exposure.

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