Morphometry of sacral hiatus and its clinical relevance in caudal epidural block

Abstract

Single bony landmark may not help in locating SH because of anatomical variations. Depth of hiatus less than 3 mm may be one of the causes for failure of needle insertion. Surrounding bony irregularities, different shapes of hiatus and defects in dorsal wall of sacral canal should be taken into consideration before undertaking caudal epidural block so as to avoid its failure.

Unravelling the Mystery Behind Successful Caudal-Epidural Block

“…Besides the anatomical landmarks, fluoroscopy remains the gold standard in guiding caudal epidural injection; though it's not always available and radioactive exposure is a matter of concern. So we can consider USG as the best modality in guiding caudal epidural injection which is easy to learn,less expensive, radiation free and can be virtually used in any clinical settings [5,10].…”

“…Knowledge of variations in anatomical features of sacral hiatus and dorsal wall of sacral canal helps us to perform caudal epidural anaesthesia, confidently and successfully.CEB is a procedure involving injection of special drugs (corticos-teroids / local anaesthetics/analgesic agents) into the epidural space through the sacral hiatus, for effective blocking of sacral nerves [5]. As early as in 1901,the first epidural anaesthesia, via caudal approach(single shot caudal blocks ) was independently described by two French physicians .Jean Anthanese Sicard ,a pathologist was the first to describe injection of dilute solutions of cocaine through the SH, into the epidural space, to treat patients suffering from severe ,intractable sciatic pain or lumbago [6].…”

Sacral Hiatus: An Anatomical Study

“…The laminae may fail to fuse above a fused part. This type is termed "aperture in the dorsal wall" 5 or "bifid" 3,7,8,9 . In the present study, the authors found sacra with deficiencies above a sacral hiatus, but these were not given a separate class.…”

Dorsal sacral dimensional anatomy-revisited

“…Sacral approach to epidural space can effectively and reliably block sacral nerves. 4 SH is an important gateway for various clinical procedures like trans-sacral thecaloscopy, CEB and injection of drugs into epidural space. 5 Due to the anatomical variations of the level of apex or difficulty in palpation of SH in some patients, certain anatomical landmarks have been described in this study which will help the clinicians to approach SH easily and perform various procedures successfully.…”