Basic Science Viva
Pages 14

It is the commonest regional technique in children and the first means of administering local anaesthetic in the epidural space dating back as early as 1901.

Indications Acute pain • Surgical: To cover area innervated by lower lumbar and sacral roots. In

younger children, the caudal block effectively covers T10-S5, although only sacral roots are blocked in older children and adults. Caudal anaesthesia is also recommended for upper abdominal surgery, but higher doses are needed to attain a high block ° Elective: anorectal, genitourinary procedures-inguinal hernia,

hypospadias, orchidopexy, circumcision ° Emergency: testicular torsion, strangulated hernia

• Nonsurgical: To provide sympathetic block in vascular insufficiency of lower extremities secondary to vasospastic disease, unrelieved perineal pain in labour (historical)

Chronic pain • Complex regional pain syndromes (CRPS) • Lumbar radiculopathy secondary to herniated discs and spinal stenosis • Backache with sciatica after failed conservative or surgical treatment • Coccydynia • Diabetic polyneuropathy

Cancer pain • Primary genital, pelvic, and rectal malignancy • Bony metastasis to the pelvis

What are the advantages of caudal over lumbar epidural analgesia?