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The caudal space in fetuses: an anatomical study

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Abstract

Purpose

The caudal epidural space is a popular site for analgesia in pediatrics. High variation in blind needle placement is common during caudal epidurals, increasing the risk of intravascular and intrathecal spread. Knowledge of safe distances and angles for accessing the caudal epidural space in premature infants can improve the safety of caudal epidural blocks.

Methods

Thirty-nine fetuses with crown–heel length between 33 and 50 cm, corresponding to gestational age of 7–9 months, were included. The dorsal surface of the sacrum from the fourth lumbar vertebra to the tip of the coccyx was dissected, following which measurements were taken on dorsal surface and midsagittal sections. The angle of depression of the needle was measured using a goniometer following the two-step method of needle insertion.

Results

Right and left sacral cornua were palpable in 23 of 39 fetuses (58.97%). Termination of dural sac was at S2 in most of the fetuses (53.84%), whereas the apex of the sacral hiatus was at S3 in most (58.97%). The distance from the apex of the hiatus to the termination of dura ranged from 3 to 13 mm; the anteroposterior distance of the canal at the apex of the hiatus ranged from 1.72 to 4.38 mm. All sacral parameters correlated with crown–heel length except inter-cornual distance, depth of canal at hiatus, and height of sacral hiatus.

Conclusion

Distances and angles for accessing the caudal epidural space in fetuses do not provide all parameters for safe performance of caudal epidural blocks in premature and low birth weight infants because the apex of the sacral hiatus and the termination of the dura show wide variation in location.

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Acknowledgments

The authors wish to thank Mr. Vijay Bakshi, senior artist of the department of anatomy for art work.

Conflict of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Anjali Aggarwal, Daisy Sahni & Harjeet Kaur

  2. Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Yatindra K. Batra & Rakesh Sondekoppam Vijayashankar

Authors
  1. Anjali Aggarwal
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  2. Daisy Sahni
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  3. Harjeet Kaur
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  4. Yatindra K. Batra
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  5. Rakesh Sondekoppam Vijayashankar
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Corresponding author

Correspondence to Yatindra K. Batra.

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Aggarwal, A., Sahni, D., Kaur, H. et al. The caudal space in fetuses: an anatomical study. J Anesth 26, 206–212 (2012). https://doi.org/10.1007/s00540-011-1271-8

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  • DOI: https://doi.org/10.1007/s00540-011-1271-8

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