Caudal Epidural Anesthesia: An Anesthetic Technique Exclusive for Pediatric Use? Is it Possible to Use it in Adults? What is the Role of the Ultrasound in this Context?

Abstract

Despite its limitations, the ultrasound can be a useful tool to position the needle in the caudal space. It allows prompt identification of the sacral anatomy and real-time visualization of the injection. Considering it is portable, non-invasive, and free of radiation exposure, it is an attractive technique in the operating room especially in difficult cases. However, since its use in neuroaxis anesthesia is very primitive, more studies are necessary to make it a routine technique in anesthetic practice.

Ultrasound-Guided vs. Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain

“…A lower-frequency transducer (2)(3)(4)(5) www.ajpmr.com was required in patients with moderate obesity for adequate needle penetration. Chen et al^° reported a 100% success rate in needle placement using a highfrequency transducer (5)(6)(7)(8)(9)(10)(11)(12) to identify the sacral hiatus during US-guided ESI procedures in 70 patients with lumbosacral neuritis. US provides more accurate anatomic information on the site of injection.…”

Caudal epidural steroid injections in postlaminectomy patients:comparison of ultrasonography and flouroscopy

“…Caudal epidural blockade procures successful results in acute pain (in pediatric and adult inguinal and pelvic operations) as well as in chronic pain conditions (particularly in low back pain, pelvic pain, etc.) (13). For many years, caudal blockade had been administered utilizing the landmark technique.…”

Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation

“…Additionally, a feasibility study of ultrasoundguided epidural steroid injection was done that showed successful placement in 28/29 attempts [43]. Additional studies have utilized ultrasound as an adjunct for measurement prior to epidural injections [44,45].…”