Caudal epidural anaesthesia

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Target exams

Red flags

• The dural sac terminates at S2 in the adult and lower in the infant; advancing the needle beyond the sacral hiatus risks a dural puncture and a total spinal — keep the needle below S2 and aspirate before injecting.
• The sacral canal is highly vascular; an intravascular injection of local anaesthetic can cause systemic toxicity — aspirate for blood and inject incrementally with a needle that allows aspiration.
• An unintended intrathecal injection (CSF on aspiration) converts a caudal into a spinal; if unrecognised, a full caudal dose produces a high or total spinal.
• Infection of the sacrococcygeal area (pilonidal disease, local sepsis) is a contraindication because the needle can carry infection into the epidural space.
• Caudal block masks the signs of surgical complications (urinary retention, haematoma, compartment syndrome) in the lower body; ensure the surgical team plans postoperative monitoring accordingly.
• A high volume of local anaesthetic in a small child can spread to the thoracic dermatomes and produce hypotension or respiratory compromise; dose by weight.