Caudal epidural block
by Baheti Dwarkadas K, Bakshi Sanjay, Gupta Sanjeeva, Gehdoo Raghbir Singh

Interventional Pain Management: A Practical Approach

by Sanjay Bakshi, Sanjeeva Gupta, Dwarkadas K Baheti, Raghbir Singh P Gehdoo
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This procedure is ideally started with the C-arm in the lateral position. It is helpful usually to manually feel for the indentation of the sacral cornua. At this point skin and subcutaneous tissues are anesthetized. Under lateral view of the fluoroscope, the needle is advanced cephalad toward the sacral hiatus at a 45° angle. If you touch bone, readjust the needle angle and try to walk the needle into the caudal canal. You will initially feel the needle entering the sacrococcygeal ligament, followed by the loss of resistance. At this point radio contrast dye is injected and appropriate dye spread is reconfirmed in both lateral and AP positions. Careful negative aspiration is done before dye injection to ensure that no blood or cerebrospinal fluid (CSF) is aspirated.

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