The Success Rate of Caudal Block Under Ultrasound Guidance and the Direction of the Needle in the Sacral Canal

초음파 영상의 유도를 이용한 미추경막외블록의 성공률과 천골관 내에서의 바늘의 방향

  • Roh, Jang Ho (Department of Anesthesiology and Pain Medicine, MizMedi Hospital) ;
  • Kim, Won Oak (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Yoon, Kyung Bong (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Yoon, Duck Mi (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine)
  • 노장호 (미즈메디병원 마취통증의학과) ;
  • 김원옥 (연세대학교 의과대학 마취통증의학교실) ;
  • 윤경봉 (연세대학교 의과대학 마취통증의학교실) ;
  • 윤덕미 (연세대학교 의과대학 마취통증의학교실)
  • Received : 2007.03.07
  • Accepted : 2007.06.11
  • Published : 2007.06.30

Abstract

Background: Caudal block is useful when anesthesia for surgery or treatment for chronic pain is needed, but this procedure has a failure rate of up to 25% even when it performed byan experienced physician. This high failure rate is usually due to improper needle placement. Methods: After gaining approval of the ethics committee, 46 patients received caudal blocks under ultrasound guidance; these were performed after the anatomical structures in the sacral hiatus had been measured with ultrasound. All these procedures were performed by the same anesthesiologist. The position and direction of the needle were identified using fluoroscopy by injecting a radio-opaque contrast through the needle. The time taken from thelidocaine injection to verification of the needle was measured and the planned nerve block was then carried out. Results: All cases of needle insertion into the sacral canal under ultrasound guidance were successful. The average duration of the procedure and the trial count were $134.1{\pm}10.1seconds$ and $1.2{\pm}0.1$, respectively. In 12 of the 46 cases (26%), the needle deviated either left or right in the sacral canal, so the direction of the needle had to be adjusted. The distance between two cornua, the depth of the sacral hiatus and the thickness and length of the sacrococcygeal ligament were $17.1{\pm}0.4$, $3.9{\pm}0.3$, $2.3{\pm}0.1$ and $24.9{\pm}0.9mm$, respectively. Conclusions: Ultrasound guidance can increase the success rate of inserting a needle into the sacral canal. However, even when ultrasound is used, the needle can deviate either left or right in the sacral canal.

Keywords

References

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