-Terminal Portion of dural sac

-filum terminale

-epidural fat

-5 sacral nerves and coccygeal nerves making up the Cauda Equina

-Sacral epidural veins

Epidural Fat. 

It changes from a loose texture in children to a more fibrous close-meshed texture in adults.

True or False:

The sacral epidural veins generally end at S4 and are therefore safe from needle puncture during the establishment of a Caudal local anesthetic.

What is the preferred position for a caudal block?

What does this allow for?

What do I need to do to make this happen?

1) Preferred position: Lateral SIMS

2) Allows for:

-Landmark indentification

-pt. comfort

-access to airway if needed.

3) Pt in lateral position

-Lower leg slightly flexed at hip

-children may be placed in "cooked shrimp" position

-If prone, toes shourl point inward or medially

1) ID the tip of the Coccyx

2) Move cephalad until your finger is over sacral hiatus

3) Prominent sacral cornu should be palpable on each side of your fingertip as you move from side to side. (this is the sacrococcygeal ligament) 

4) Draw an equilateral triangle (imaginary I believe)

upside down with the point towards coccyx.

1) insert the needle at sacral hiatus (between Sacral Cornu) at 120 degrees until you feel a "pop"

You are now through the sacrococcygeal ligament.

2) Once through, drop needle and align with long access of canal and insert the needle an additional 1 cm.

3) Inject 2 cc of air.  You should feel the space bulge. 

-If you feel crepitus you are in the wrong place

4) Aspirate

-If you aspirate CSF or blood, you are in the wrong place. 

5) Give Dose for Caudal Block.