116 - Caudal Epidural Block: Lateral Position

Abstract

Performing caudal epidural nerve block with the patient in the lateral position is one of the most technically demanding regional anesthesia techniques. Despite the difficulty of this approach, the use of the lateral position expands the number of patients in whom caudal epidural block can be performed to include those who cannot assume the prone position because of fractures, pregnancy, or severe pulmonary insufficiency. Use of the lateral position allows the pain management specialist to capitalize on the safety and lack of pain associated with the caudal approach to epidural nerve block. For these reasons, as well as the simplicity of the caudal block when performed with the patient in the prone position, caudal epidural nerve block is rapidly replacing the lumbar approach to the epidural space for a number of pain management applications at many pain management centers. In addition to applications for surgical and obstetric anesthesia, caudal epidural nerve block with local anesthetic can be used as a diagnostic tool when differential neural blockade is performed on an anatomic basis in the evaluation of pelvic, bladder, perineal, genital, rectal, anal, and lower extremity pain. If destruction of the lower lumbar or sacral nerves is being considered, this technique can be used in a prognostic manner to indicate the degree of motor and sensory impairment that the patient may experience.