Faculty Opinions recommendation of A randomized comparison of caudal block by sacral hiatus injection under ultrasound guidance with traditional sacral canal injection in children.

Background and Objectives: This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Under ultrasound guidance, after advancing the introducer needle through the sacrococcygeal ligament and then slowly withdrawing it, the outer catheter was continuously advanced into the sacral hiatus. We confirmed proper needle placement under fluoroscopic imaging, using 5 mL of contrast media. We assessed the contrast spread pattern with fluoroscopic imaging and checked it for the presence of intravascular injection. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy under ultrasound guidance, without intravascular uptake, as confirmed by contrast media fluoroscopy. The incidence of ventral spread was 84.2% above the S1 with 5 mL of contrast. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection. Thus, this technique is a reliable option for conventional caudal block.

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Ultrasound assessed a new method of needle insertion at an angle of 90°to the apex of the sacral hiatus for caudal block in newborns: a randomized controlled study

10.21203/rs.2.9519/v1 ◽

2019 ◽

Author(s):

Shangyingying Li ◽

Yanzhe Tan ◽

Fei Yang ◽

Lifei Liu ◽

Shengfen Tu

Keyword(s):

Failure Rate ◽

Conventional Method ◽

Local Anesthetic ◽

Needle Insertion ◽

New Method ◽

Controlled Study ◽

Minimal Risk ◽

Caudal Block ◽

Sacral Hiatus ◽

Method Group

Abstract Background Caudal block is widely used in paediatric anaesthetic practice. Many angles for needle insertion were compared to find a optimal angle during caudal block with high successful caudal injection and minimal risk of complications. The aim of this study is to evaluate the safety and effectivity of a new method of needle insertion at an angel of 90°to the apex of the sacral hiatus for caudal block in newborns. Methods Sixty patients were included in our study, aged 0 to 28 days, posted for inguinal hernia surgery, randomly divided into two groups: a conventional method (CM) group and a new method (NM) group. In both groups, 1 ml∙kg-1 0.5% lignocaine at a rate of approximately 0.5 ml∙s-1 was given for caudal blocks after anaesthesia, and ultrasonographic observation of local anesthetic in the epidural space. Failure rate at the first attempt, puncture frequency, complications, and durations of block were recorded. Results The failure rate at the first attempt of caudal block were 16.7% in the conventional method group and 3.3% in the new method group (p<0.05). The mean time required (standard deviation) to perform needle insertion in the conventional method group was 2.6±0.5 minutes and in new method group 1.6±0.5 minutes (p<0.05). There were three cases aspirating the needle to find blood and one case to find cerebrospinal fluid in the conventional method group. The majority level which the local anesthetic reached are L1 by ultrasound imaging, 86.7% in the conventional method group and 83.3% in the new method group. Conclusion The study found that using the new method, the chance of performing a successful caudal injection can be increased, the time and the risk can be minimized compared to conventional technique. It is a safe and effective method.

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Ultrasound Evaluation of the Sacral Area and Comparison of Sacral Interspinous and Hiatal Approach for Caudal Block in Children

Anesthesiology ◽

10.1097/aln.0b013e3181bc6dd4 ◽

2009 ◽

Vol 111 (5) ◽

pp. 1135-1140 ◽

Cited By ~ 31

Author(s):

Seo K. Shin ◽

Jeong Yeon Hong ◽

Won Oak Kim ◽

Bon Nyeo Koo ◽

Jee Eun Kim ◽

...

Keyword(s):

Success Rate ◽

Clinical Characteristics ◽

Success Rates ◽

Caudal Block ◽

Dural Sac ◽

Ultrasound Evaluation ◽

Ultrasound Study ◽

Regional Technique ◽

Linear Probe ◽

Sacral Hiatus

Background Although caudal block via the sacral hiatus is a common regional technique in children, it is sometimes difficult to identify the hiatus. A needle approach via the S2-3 interspace can be used as an alternative to the conventional approach. The authors compared the feasibility and clinical characteristics between the S2-3 approach and hiatal approach, in addition to ultrasound study. Methods Sacral space depth, dural sac end level, and caudal space depth were evaluated using ultrasound with high-frequency linear probe in the lateral decubitus position in 317 anesthetized children (study 1). In another 162 children who underwent ambulatory urological surgeries, success rate, drug spread, and clinical characteristics were compared between the hiatal and S2-3 approaches (study 2). Results The dural sac end level was S2U (S3M-L5M). The median depth of the sacral space at the S2-3 level was 7.3 mm, whereas the caudal space depth at the hiatus was 2.9 mm. The overall success rate was 96.3% in both groups. The success rates at the first puncture attempt were 96.2% in the S2-3 group and 77.5% in the hiatus group. Drug spread level and clinical characteristics were similar between the two groups. Conclusions The S2-3 approach can be applied as a useful fallback method to the conventional landmark approach in children, especially in those older than 36 months who present with difficult identification of the sacral hiatus.

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Anatomical Variations and Clinical Correlations of Sacral Hiatus and Sacral Canal

Journal of Medical Academics ◽

10.5005/jp-journals-10070-0016 ◽

2018 ◽

Vol 1 (2) ◽

pp. 75-80

Author(s):

Ruchi Dhuria ◽

Vandana Dave ◽

Manish Ahuja ◽

Shaifaly M Rustagi

Keyword(s):

Anatomical Variations ◽

Sacral Hiatus ◽

Clinical Correlations ◽

Sacral Canal

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Minimally Invasive Approach for Drainage of a Sacral Epidural Abscess

Interventional Neuroradiology ◽

10.1177/159101990701300206 ◽

2007 ◽

Vol 13 (2) ◽

pp. 161-165 ◽

Cited By ~ 2

Author(s):

V.J. Kostanian ◽

M.S. Mathews

Keyword(s):

Minimally Invasive ◽

Open Surgery ◽

Epidural Abscess ◽

Lumbosacral Spine ◽

Low Grade ◽

Disc Space ◽

Invasive Approach ◽

Effective Manner ◽

Sacral Hiatus ◽

Sacral Canal

Sacral epidural abscesses are rare infections, often managed with open surgery, especially in the presence of acute neurological symptoms. We report a novel approach for minimally invasive drainage of sacral epidural abscesses. A 51-year-old man presented to the emergency department complaining of low back pain, generalized muscle pain, pain across several large joints, low-grade fever, and weakness of both legs for ten days. MRI of the patient's lumbosacral spine showed osteomyelitis involving his L5, S1 vertebrae, L5-S1 discitis, as well as anterior and posterior epidural abscesses extending from L5-S1 disc space to the S2 vertebral level. Under CT fluoroscopic guidance a 20-gauge spinal needle was inserted into the sacral hiatus, parallel to the pelvic surface of the sacral canal, and directed cranially. A 0.18-gauge microwire was then advanced through the 20-gauge needle. The 20-gauge needle was exchanged over the guidewire for an 18-gauge blunt tipped needle which was curved to approximate the contours of the sacral canal. The curved needle was inserted through the sacral hiatus with its concavity initially facing upwards, and then rotated 180° to gain access to epidural abscess. Once anatomic access was established 5cc of thick purulent material was evacuated. The patient tolerated the procedure well, and no focal nerve root symptoms were noted following the procedure. Image guided aspiration of sacral epidural abscesses can be carried out in a safe and effective manner using CT fluoroscopy. Aspiration of these abscesses combined with intravenous antibiotics may be an alternative to open surgery in select patients.

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