2. Caudal Anaesthesia

Question 1

What surgical procedures is caudal useful for

Answer 1

1. General Surgery
   - Inguinal hernia repair
   - Surgery on distal GI tract (rectum / anus)
   - Orchidopexy / circumcision
2. Urology
   - Hypospadias repair
   - Orchidopexy / crc
3. Other
   LL plastic / orthopaedic surgery

Question 2

Technique

consent / set up

Answer 2

Standard Hx / Exam / Consent

SLIMRAG

Sterile technique
Light source
Iv access
Monitoring
Resus equipment
Assistant trained
Ga conversion possibility

Question 3

Technique

position
ID

Answer 3

Left lateral
Hips knees flexed to 90

Confirm boundaries of hiatus

• Equilateral triangle w/ Sacral cornu inferiorly
• Apex body S4 Superiorly

ID puncture site - clean 0.5 Chlorhex /
allow evaporate before proceeding

Question 4

Technique procedure

Answer 4

Blunt short bevel inserted at 45
Until click felt as passes sacrococcygeal membrane

Then needle directed in cephalad direction
along long axis of canal

(can also use IV cannula membrane pierce - needle withdraw and blunt cannula advance - reduces accidental Dural puncture

Should advance easy - resistance reinsert

Question 5

During procedure

Answer 5

ECG monitoring - mandatory exclude IV injection

Confirmation
Aspiration - exclude Subarach / IV

Ease injection - no resistance

US may confirm epidural spread

Question 6

Drugs

Answer 6

Armitage regiment

0.25% bupiv - vol calculated to level of block desired

Lumbrosacral 0.5ml/kg

thoracolumbar 1 ml /kg

Mid Thoracic 1.25ml/kg

Additives -
Clonidine 1-2mcg/kg
Ketamine preservative free 0.5mg.kg

Question 7

Complications of caudal

Answer 7

IV / IO Injection

Dural puncture

Motor Block

Urinary retention

Perforation rectum

Subcut injection

Haematoma

Failure