Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Two. Neuraxial Anesthesia > Chapter 15. Caudal Anesthesia Kenneth D. Candido, MD, Alon P. Winnie, MD

Caudal Anesthesia: Introduction

"Caudal anesthesia was first described at the turn of last century by two French physicians, Fernand Cathelin and Jean-Athanase Sicard. The technique predated the lumbar approach to epidural block by several years.¹ Caudal anesthesia, however, did not gain in popularity immediately following its inception. One of the major reasons caudal anesthesia was not embraced arose from the wide variety of arrangements of sacral bones encountered in the general population and the consequent high failure rate associated with attempts to locate the sacral hiatus. The failure rate of 5% to 10% made caudal epidural anesthesia unpopular until a resurgence of interest occurred in the 1940s led by Hingson and colleagues, who used it primarily in obstetrical anesthesia. Caudal epidural anesthesia has many applications, including surgical anesthesia in children and adults, as well as the management of acute and chronic pain conditions. Success rate of 98% to 100% can be achieved in infants and young children before the age of puberty, as well as in lean adults.¹ The technique of caudal epidural block in pain management has been greatly enhanced by the use of fluoroscopic guidance and epidurography, in which high success rates can be attained. Unfortunately, clinical indications, and especially therapeutic interventions for the relief of chronic pain in individuals with failed back surgery syndrome, are often most prevalent in patients with difficult caudal landmarks. It has been suggested that traditional lumbar peridural block should not be..."