REINVENTING ADULT CAUDAL EPIDURAL BLOCK: A RETROSPECTIVE ANALYSIS

Davies C. Vergheese*, Kamal Sonya, Sahir Aftab and Sandeep David

ABSTRACT

Introduction: Caudal epidural block is useful to provide anaesthesia for perineal and penile surgical procedures in the adults. But, it is not popular among the anaesthetists due to the high failure rate with the landmark based technique. Ultrasound scanning helps to visualise the sacral hiatus, sacrococcygeal ligament and the caudal epidural space. Real-time needling and injection into the caudal epidural space can be done precisely under ultrasound guidance. This may improve the success rate so that it is a viable alternative. Ultrasound guided caudal blocks are regularly practiced in our institute for the last six years. Material and Method: Caudal blocks done in adults in the year 2016 was analysed retrospectively in this study. This included 306 patients above 18years. Results: The study showed a success rate of 92.19% against the 68- 75% reported for the adult caudal block by the landmark technique. It provided good and prolonged post operative analgesia. The first rescue analgesic request was a median 604 minutes with a standard deviation of 155 minutes. No incidence of Post Operative Urinary Retention (POUR) demanding catheterisation of the bladder was noted, which is common in perineal procedures done under spinal or general anaesthesia. The incidence of spinal puncture head ache of the spinal anaesthesia is totally avoided. Oral liquids were allowed up to 2 hours before the start of surgery. Post operatively oral liquids were started once the patient is out of the procedural sedation. Only 27 patients (8.8%) received intravenous fluids, of volume 300 to 1000 ml. Conclusion: Perineal and penile procedures can conveniently be done under caudal epidural block in adults. Ultrasound guidance improves the efficiency, safety and patient comfort of caudal block in adults; and make it a practical and viable option. It provides good and prolonged post operative analgesia. Post Operative Urinary Retention (POUR) which is common after perineal procedures done under spinal or general anaesthesia may be totally avoided. Overall, Caudal block in adults enhances the ‘Enhanced Recovery After Surgery’.

Keywords: ultrasound guided regional anaesthesia, caudal epidural block, Ropivacaine, Post Operative Urinary Retention (POUR), Enhanced Recovery After Surgery (ERAS).