Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram

Abstract

The objective of this study was to assess the accuracy of blind placement of caudal epidural needles and the usefulness of the radio-contrast epidurogram. The study involves a prospective case series of 147 consecutive patients with radiological assessment of blind needle placement and epidurogram assessing the accuracy of blind needle placement in caudal epidurals. When the surgical miss rate (26%) and failure of flow of the therapeutic agents (6%) are combined, it can be deduced that up to 32% of nonradiologically guided caudal epidurals may fail to deliver the therapeutic agents to the site of pathology. There was no significant difference in the accuracy of needle placement in adequately trained and experienced middle grade surgeons when compared with consultant surgeons performing these procedures regularly. In conclusion, we recommend radiological guidance and use of epidurogram as the gold standard for the administration of caudal epidurals to increase the likelihood of successful delivery of the therapeutic agents to the site of pathology during the procedure.

Caudal Epidural Block: An Updated Review of Anatomy and Techniques

“…In children, the successful rate with the blind technique is above 96% [1, 2]. In adults, however, it was only 68–75% even in the experienced hands [3–5]. With the advent of imaging technology, fluoroscopy and ultrasonography have been increasingly used to guide caudal epidural block.…”

The caudal space in fetuses: an anatomical study

“…Crucial to the success of caudal epidural block is identification of the sacral hiatus and knowledge about the direction and depth of needle insertion. The rate of failure could be much higher than in adults [11] because of the narrow dimensions of the canal. The proximity to other structures, such as dura, which is greater in this population, makes performance of caudal block more challenging to the anesthesiologist, necessitating accurate knowledge of the anatomy of the region.…”

Vertical Small-Needle Caudal Epidural Injection Technique

“…The frequency of anatomic irregularities resulting in failed caudal epidural with fluoroscopically-guided method varies from 1% - 3% when documented (4, 11, 16, 17). Reasons for epidural failure are primarily due to unusual anatomy such as a narrow sacral canal interfering with needle advancement beyond the cornua, particularly with a spinal canal height of 1.5 mm or less (18).…”