Caudal block in a child with a sacral dimple utilizing ultrasonography

25 years of experience, thousands of caudal blocks, and no dural puncture. What happened today?

“…Ultrasound has been used to guide the performance of caudal injections. After ultrasonography revealed normal sacrum anatomy, a caudal injection was performed in an 18-month-old patient with a sacral dimple (5). If the sacrum of our patient had been examined with ultrasonography, the dural puncture might have been avoided, but is possible that the presence of a provider with significant experience in ultrasonography would be necessary to accomplish this goal.…”

Should we abandon landmark‐based technique for caudal anesthesia in neonates and infants?

“…Incomplete ossification of the posterior vertebral elements can make identification of the sacrococcygeal membrane for neonatal caudal anesthesia difficult (Figure ). Some authors have also reported a higher incidence of abnormal sacral anatomy in infants with sacral dimples and in infants with urogenital anomalies . Both these conditions may make caudal anesthesia difficult or inadvisable and potentially increase the risk of inadvertent intravascular, intrathecal or intraosseous deposition of local anesthetic.…”

Ultrasonography-guided ilioinguinal-iliohypogastric nerve block for inguinal herniotomies in ex-premature neonates

“…In the presence of cutaneous stigmata for spina bifida, ultrasonography may be used to locate the tip of the dural sac before proceeding with a caudal block to mitigate the risk of dural puncture. (2) A safer alternative would be to perform an ilioinguinal-iliohypogastric (IG-IH) nerve block.…”