Caudal block in adult patients and its use in the perioperative period

Authors: K. Axmann 1;  M. Pieran 1;  E. Berta 2,3;  T. Gabrhelík 4
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Olomouc 1;  Ústav molekulární a translační medicíny, Lékařská fakulta Univezity Palackého v Olomouci 2;  Ringerike Hospital, VVHF, Hønefoss, Norsko 3;  Oddělení anesteziologie, resuscitace a intenzivní medicíny, Krajská nemocnice Tomáše Bati, a. s. 4
Published in: Anest. intenziv. Med., 30, 2019, č. 1, s. 33-38


Caudal block is a well-known and thoroughly studied technique of neuraxial anaesthesia routinely performed in paediatric anaesthesia. In adults, however, this method has been used mostly in chronic pain management. Due to more detailed understanding of anatomy and the routine use of ultrasound guidance, caudal block has recently been reintroduced into perioperative care in adults. It is now considered a simple, safe and reliable technique for both anaesthesia and postoperative analgesia in this group of patients. This review describes the anatomy and technical aspects with a focus on ultrasound guidance as well as suitable applications of this block in the perioperative setting in adults.


caudal block – regional anaesthesia – ultrasound – analgesia

  1. Franco A, Cortés J, Díz C, Alvarez J. History of the sacral epidural block. Rev Esp Anestesiol Reanim. 2011 Jan;58:42–47.

  2. Mai CL, Coté CJ. A history of pediatric anesthesia: a tale of pioneers and equipment. Paediatr Anaesth. 2012;22:511–520.

  3. Hurdle MF. Ultrasound-guided spinal procedures for pain: A review. Phys Med Rehabil Clin N Am. 2016;27:673–686.

  4. Joo J, Kim J, Lee J. The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging. Anaesthesia. 2010;65:23–26.

  5. Senoglu N, Senoglu M, Ozkan F, et al. The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults. Surg Radiol Anat. 2013;35:579–584.

  6. Kao SC, Lin CS. Caudal epidural block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:9217145. doi: 10.1155/2017/9217145.

  7. Sekiguchi M, Yabuki S, Satoh K, Kikuchi S. An anatomic study of the sacral hiatus: a basis for successful caudal epidural block. Clin J Pain. 2004;20:51–54.

  8. Aggarwal A, Aggarwal A, Harjeet, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat. 2009;31:793–800.

  9. Aggarwal A, Kaur H, Batra YK, et al. Anatomic consideration of caudal epidural space: a Cadaver study. Clin Anat. 2009;22:730–737.

  10. Park GY, Kwon DR, Cho HK. Anatomic differences in the sacral hiatus during caudal epidural injection using ultrasound guidance. J Ultrasound Med. 2015 Dec;34:2143–2148.

  11. Kim YH, Park HJ, Cho S, Moon DE. Assessment of factors affecting the difficulty of caudal epidural injections i adults using ultrasound. Pain Res Manag. 2014;19:275–279.

  12. Senoglu N, Senoglu M, Oksuz H, et al. Landmarks of the sacral hiatus for caudal epidural block: an anatomical study. Br J Anaesth. 2005;95:692–695.

  13. Barham G, Hilton A. Caudal epidurals: the accuracy of blind needle placement and the value of a confirmatory epidurogram. Eur Spine J. 2010;19:1479–1483.

  14. Lewis MP, Thomas P, Wilson LF, Mulholland RC. The “whoosh” test: a Clinical test to confirm correct needle placement in caudal epidural injections. Anaesthesia. 1992;47:57–58.

  15. Eastwood D, Williams C, Buchan I. Caudal epidurals: the whoosh test. Anaesthesia. 1998;53:305–307.

  16. Stitz MY, Sommer HM. Accuracy of blind versus fluoroscopically guided caudal epidural injection. Spine (Phila Pa 1976). 1999;24:1371–1376.

  17. Klocke R, Jenkinson T, Glew D. Sonographically guided caudal epidural steroid injections. J Ultrasound Med. 2003;22:1229–1232.

  18. Chen CP, Tang SF, Hsu TC, et al. Ultrasound guidance in caudal epidural needle placement. Anesthesiology. 2004;101:181–184.

  19. Blanchais A, Le Goff B, Guillot P, et al. Feasibility and safety of ultrasound-guided caudal epidural glucocorticoid injections. Joint Bone Spine. 2010;77:440–444.

  20. Chin KJ, Karmakar MK, Peng P. Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade. Anesthesiology. 2011;114:1459–1485.

  21. Yoon JS, Sim KH, Kim SJ, et al. The feasibility of color Doppler ultrasonography for caudal epidural steroid injection. Pain. 2005;118:210–214.

  22. Shanthanna H, Singh B, Guyatt G. A systematic review and meta-analysis of caudal block as compared to noncaudal regional techniques for inguinal surgeries in children. Biomed Res Int. 2014;2014:890626. doi: 10.1155/2014/890626.

  23. Guay J, Choi P, Suresh S, et al. Neuraxial blockade for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014;25.

  24. Apan A, Cuvas O. Caudal block in adults: new horizons with ultrasound. Minerva Anestesiol. 2013;79:1332–1333.

  25. Köse EA, Öztürk A, Ateş G, Apan A. Caudal epidural block for elderly patients who have limited cardiac reserve. Turkish Journal of Medical Sciences. 2012;42(Sup. 1): 1347–1351.

  26. Urabe F, Kimura T, Shimomura T, et al. Prospective comparison of the efficacy of caudal versus periprostatic nerve block, both with intrarectal local anesthesia, during transrectal ultrasonography-guided prostatic needle biopsy. Scand J Urol. 2017;51:245–250.

  27. Isoyama-Shirakawa Y, Nakamura K, Abe M, et al. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer. J Radiat Res. 2015;56:583–587.

  28. Schloss B, Martin D, Tripi J, et al. Caudal epidural blockade for major orthopedic hip surgery in adolescents. Saudi J Anaesth. 2015;9:128–131.

  29. Manchikanti L, Knezevic NN, Boswell MV, et al. Epidural injections for lumbar radiculopathy and spinal stenosis: a Comparative systematic review and meta-analysis. Pain Physician. 2016;19:E365–410.

  30. Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a Systematic review and meta-analysis. Ann Intern Med. 2015;163:373–381.

  31. Lundblad M, Lönnqvist PA. Adjunct analgesic drugs to local anaesthetics for neuroaxial blocks in children. Curr Opin Anaesthesiol. 2016;29:626–631.

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