Caudal (sacral) anesthesia

Description:

Caudal (sacral) anesthesia is a kind of epidural anesthesia and consists in administration of solution of local anesthetic to the sacral canal through a sacrococcygeal sheaf. The entered anesthetic gets to a sacral epidural space, spreading further, and number of the taken segments in direct ratio to amount of the administered drug.
Indications:
– operative measures on a crotch and an anorectal zone;
- anesthesia and an analgesia in obstetrics;
- interventions are lower than navel level;
- the prolonged epidural anesthesia in pediatrics.

Contraindications:
- refusal of the patient;
- an infection in an injection zone;
- a coagulopathy or reception of anticoagulants (according to recommendations about carrying out RA at the patients receiving similar drugs);
- cyst of a tailbone or any congenital anomalies of sacrococcygeal area, spinal cord or its covers.

Tools

- the syringe of 2 ml with a needle for local anesthesia of skin;
- two syringes on 20 ml for administration of anesthetic;
- connecting tube;
- needle of 22 G in size and 4-7 cm long;
- set for the prolonged epidural anesthesia (if catheterization is planned);
- balls, napkins.

Drugs
For carrying out caudal anesthesia the same drugs, as for usual epidural anesthesia are used. At the same time, it is necessary to consider that in connection with leak of drug through side sacral openings and the large volume of the channel, for caudal anesthesia large volumes of anesthetics are required. On average receiving perineal anesthesia at adults requires 15 ml of solution, at the same time receiving anesthesia at the T10-T12 level requires already 25 ml, in recalculation it will make approximately 2-3 ml on a segment. Decrease in volume of the entered solution on a third is required from pregnant women. Concentration of solutions of anesthetics are selected as well as at epidural blockade. 1% solution of lidocaine, 0,5 and 0,25% solutions of bupivacaine, 0,75-0,5% solutions of a ropivakain are most often applied. Addition of adrenaline to solutions lidocaine (1:200 000) allows to improve quality and duration of blockade.

Equipment
Anesthesia can be executed in classical position of the patient on a stomach, and also in genucubital situation, edgewise position or knee and chest situation. Classical position of the patient on a stomach with knees a little divorced and rotirovanny inside is most often applied:
- the specified situation reaches the greatest relaxation of gluteuses. Contrary to this situation, data of legs cause tension of gluteuses and complicate definition of anatomic reference points;
- at children use edgewise position as anesthesia at them is carried out in the conditions of a superficial anesthesia. Use of intermediate option between edgewise position and situation on a stomach is also possible, in this case control over passability of VDP remains and well anatomic reference points are defined;
- when using genucubital situation under hips of the patient place a pillow with the purpose to record bending in a femoral joint and cultivation of muscles, besides, the patient legs also ask to part and to turn feet inside;
- after the occupation the patient of necessary situation identify anatomic reference points. For this purpose represent an isosceles triangle as which tops serve both upper back awns of ileal bones and a sacral crack. The sacral channel can be defined, palpating at first a tailbone, and then displacing a finger kranialno to feeling of a progibaniye of skin. Adults have a distance from a tailbone tip to the sacral channel approximately too, as distance from a tip of an index finger to a proximal interphalangeal joint. It is very important to establish the average line of a sacrum.

Special attention should be paid on processing of skin in the place of a puncture which has to be carried out with all care in order to avoid entering of an infection to the sacral canal. For prevention of running off of solution in a crotch the small tampon is placed in an interbuttock fold.

After processing of skin make a local infiltration anesthesia for what over a sheaf vnutrikozhno, and then and a small amount of local anesthetic is subcutaneously entered. It is necessary to avoid widespread infiltration as it will complicate identification of anatomic reference points.