Caudal block 미추신경공 차단술

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Caudal block

PSIS, Sacral cornu, Sacral hiatus

Landmarks

Caudal Epidural Steroid Injections

The caudal epidural approach involves insertion of a spinal needle into the sacral hiatus, a hole located just above the tailbone.

Caudal epidural injections require larger volumes of injected fluids than lumbar, thoracic and cervical ESI.

Depending on the proposed pain generator, 10 to 15 ml of injection mixtures is recommended.

This will often require dilution of steroid with sterile saline and local anesthetic.

Caudal Epidural Steroid Injections

In an adult, the distance from the tip of the coccyx to the sacral hiatus is approximately the same as the distance from the tip of the index finger to the proximal inter- phalangeal joint.

Caudal Epidural Steroid Injections

The sacral hiatus and the posterior superior iliac spines form an equilateral triangle pointing inferiorly. 

The sacral hiatus can be located by first palpating the coccyx, then sliding the palpating finger cephalad until a depression in the skin is felt. 

Always above intergluteal folds.

A 22 gauge short beveled cannula or needle is directed at about 45° to skin and inserted till a "click" is felt as the sacro-coccygeal ligament is pierced (position 1). The needle is then carefully directed in a cephalad direction at an angle approaching the long axis of the spinal canal (position 2).'

Aspirate, looking for CSF or blood.

If the test is negative, this is followed by the injection of a 3ml test dose of local anesthetic, with a hand positioned over the sacrum to detect any tissue swelling resulting from malposition of the needle or catheter either subperiosteally or along the dorsal surface of the sacrum.

If CSF is aspirated or if blood continues to be aspirated after repositioning of the needle or catheter, the block should be abandoned.

Following a negative test dose and in the absence of pain on injection, the definitive dose may be injected slowly in small, repeated increments.

Single-shot needles or cannula are withdrawn following injection. Catheters are affixed to their connectors and filters and strapped in position.