Caudal Block- Just Going Thru Sacrococcygeal Ligament only Works 68% of Time But…

It has been suggested just going thru sacrococcygeal ligament is enough to get into epidural space. Imaging shows it works 68% of time, while advancing up 1 cm works 95.8% of time. However, intravascular injection occurred 25% of time where advanced into canal while 0% when not.

Korean J Pain. 2015 Apr;28(2):122-8. doi: 10.3344/kjp.2015.28.2.122.
A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block.
Doo AR(1), Kim JW(1), Lee JH(1), Han YJ(1), Son JS(1).
http://pdf.medrang.co.kr/paper/pdf/Jkp/Jkp028-02-08.pdf

  • 49 cases
  • Ultrasound for placement and Contrast dyed fluoroscopy for spread
  • one group needle just penetrated sacrococcygeal ligament; other needle was advance 1 cm up
  • though aspiration of cerebrospinal fluid and blood was done, it obviously was not very effective as 25 % of the needle advanced cases showed intravascular spread. However the non-advanced needle placement showed not intravascular spread.

Comment – Considering 25% of the advanced ones went intravascular, then only 95.8 – 25 = 70.8 were really successful – the same as not advanced. However it is not likely all material went intravascular so… Since switching to just injecting D5W with little B12, I have not had to worry re iv spread but the blocks have to be repeated frequently.

any comments?

  cgdoudouneparka cgdoudouneparka

This entry was posted in Back Pain, Injection. Bookmark the permalink.

Leave a Reply

Your email address will not be published.