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?