J Korean Soc Spine Surg.  2013 Dec;20(4):178-183. 10.4184/jkss.2013.20.4.178.

The Effectiveness of Ultrasound Guidance in Caudal Epidural Block

• Jung H
• Kim DH
• Jeon SH
• Kim CY
• Kim JS
• Choi YS

• KMID: 1896947
• DOI: http://doi.org/10.4184/jkss.2013.20.4.178

Abstract

STUDY DESIGN: A prospective study.
OBJECTIVES
To evaluate the effectiveness of ultrasound guidance in caudal epidural block and sonographic feature of sacral hiatus. SUMMARY OF LITERATURE REVIEW: High success rate of ultrasound-guided regional nerve block has been reported and recently, ultrasound-guided nerve block in spinal field has been introduced.
MATERIALS AND METHODS
Ultrasound-guided caudal epidural block was performed in 48 patients with radiating pain to leg. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. After measuring the intercornual distance, thickness of sacrococcygeal membrane and depth of sacral canal in transverse view, then the probe was rotated 90degrees to obtain the longitudinal view of the sacral hiatus. Under ultrasound guidance, a 21-gauge needle was inserted into the sacral hiatus in parallel with sacrum base. After contrast dye injection, needle placement was checked by the fluoroscopy and then medication was injected into the caudal epidural space. We investigated the change of radiating pain after caudal epidural block using visual analogue scale(VAS).
RESULTS
The intercornual distance was mean 16.4+/-2.3mm, thickness of sacrococcygeal membrane was mean 2.8+/-0.9mm and depth of sacral hiatus was mean 2.6+/-0.9mm. There was 97.9% success rate of the caudal epidural block under ultrasound guidance. The mean VAS for radiating pain was improved from 7.5+/-0.7 before the block to 2.8+/-1.5 after the block.
CONCLUSIONS
Ultrasound-guided caudal epidural block seems to provide good anatomical landmark of sacral hiatus and an effective tool with high success.

Keyword

Ultrasound; Caudal epidural block

MeSH Terms

Epidural Space
Fluoroscopy
Humans
Leg
Membranes
Needles
Nerve Block
Prone Position
Prospective Studies
Sacrum
Ultrasonography*

Figure

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  Fig. 1. The transducer was placed transversely on the sacral hiatus and checked intercornual distance, thickness of sacrococcygeal membrane, depth of caudal space. (A) Photo, (B) Ultrasound finding.

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  Fig. 2. The transducer was rotated 90 degrees to obtain the longitudinal view of sacral hiatus. (A) Photo, (B) Ultrasound finding.

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  Fig. 3. Needle was inserted to caudal epidural space under ultrasound guidance. (A) Photo, (B) Ultrasound finding.

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  Fig. 4. Contrast dye was spread into sacral canal and Christmas-tree like appearance was observed. (A) Posterior-anterior view, (B) Lateral view.

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