Reliable Routes For 100% Caudal Anesthesia in Adults

Abstract

Background: The usefulness of the adult caudal anesthesia is worldwide acceptable in lower limb surgeries. Adult caudal anesthesia through the hiatus provides maximal hemodynamic stability with profound postoperative analgesia, although, anatomical distortion of the sacral hiatus in elderly persons handicapped this technique. Aims: The study is scheduled to find out ways to overcome the obstruction to get the access to sacral epidural space in adult life. Methods: 30 (thirty) elderly patients for lower limbs’ surgeries were recruited for the study, and it was planned to attempt all patients for caudal anesthesia firstly through the sacral hiatus, next through the sacral foramens in previously unsuccessful cases and lastly through the drilling hole on the sacral hiatus in failed cases by previous two methods. The caudal anesthesia in all cases was administered by deposition of 25 ml of 0.5% ropivacaine with help of a nerve stimulator needle after local infiltration with 6 ml of 1% injection xylocaine. Results: Only 5 cases out of 30 patients (16.6%) were successfully administered caudal anesthesia through the sacral hiatus. 20 patients out of 25 cases (80%) were successfully administered caudal anesthesia through dorsal foramen of sacrum. Lastly five patients out of 5 cases (100%) were successfully administered caudal anesthesia through drilling hole on sacral hiatus. Conclusion: Caudal anesthesia is possible in 100% elderly patients either through sacral hiatus or through its dorsal foramen of sacrum or through the drilling hole over sacral hiatus. It is exclusively one of the best techniques of anesthesia for the lower limbs’ surgeries.