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Measuring the depth of the caudal epidural space to prevent dural sac puncture during caudal block in children

 Hyun Jeong Lee  ;  Ji Young Min  ;  Hyun Il Kim  ;  Hyo‐Jin Byon 
 PEDIATRIC ANESTHESIA, Vol.27(5) : 540-544, 2017 
Journal Title
Issue Date
Age Factors ; Algorithms* ; Anesthesia, Caudal/adverse effects* ; Anesthesia, Caudal/methods* ; Body Height ; Body Surface Area ; Body Weight ; Child ; Child, Preschool ; Dura Mater/injuries* ; Epidural Space/anatomy & histology* ; Epidural Space/diagnostic imaging* ; Epidural Space/growth & development ; Female ; Humans ; Infant ; Ligaments/anatomy & histology ; Ligaments/diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Needles ; Retrospective Studies ; Sacrococcygeal Region/anatomy & histology ; Sacrococcygeal Region/diagnostic imaging
anesthesia, caudal ; anesthesia, regional ; child ; epidural space ; magnetic resonance imaging ; needles
BACKGROUND: Caudal blocks are performed through the sacral hiatus in order to provide pain control in children undergoing lower abdominal surgery. During the block, it is important to avoid advancing the needle beyond the sacrococcygeal ligament too much to prevent unintended dural puncture. This study used demographic data to establish simple guidelines for predicting a safe needle depth in the caudal epidural space in children.

METHODS: A total of 141 children under 12 years old who had undergone lumbar-sacral magnetic resonance imaging were included. The T2 sagittal image that provided the best view of the sacrococcygeal membrane and the dural sac was chosen. We used Picture Achieving and Communication System (Centricity® PACS, GE Healthcare Co.) to measure the distance between the sacrococcygeal ligament and the dural sac, the length of the sacrococcygeal ligament, and the maximum depth of the caudal space.

RESULTS: There were strong correlations between age, weight, height, and BSA, and the distance between the sacrococcygeal ligament and dural sac, as well as the length of the sacrococcygeal ligament. Based on these findings, a simple formula to calculate the distance between the sacrococcygeal ligament and dural sac was developed: 25 × BSA (mm).

CONCLUSION: This simple formula can accurately calculate the safe depth of the caudal epidural space to prevent unintended dural puncture during caudal block in children. However, further clinical studies based on this formula are needed to substantiate its utility.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyun IL(김현일) ORCID logo https://orcid.org/0000-0003-2665-8620
Min, Ji Young(민지영)
Byon, Hyo Jin(변효진)
Lee, Hyun Jeong(이현정)
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