Determining the extent of the dural sac for the performance of caudal epidural blocks in newborns.

ABSTRACT

BACKGROUND: Information regarding the position and relationship of vital structures within the caudal canal is important for anesthesiologists who perform a caudal block. This information can be acquired by anatomical dissection, with ultrasound technology, or radiological studies. AIMS: The aim of this study was to determine the position of the dural sac in neonates by measuring the distance of the termination of the dural sac from the apex of the sacral hiatus in neonatal cadavers. METHODS: After careful dissection, the distance from the apex of the sacral hiatus to the dural sac was measured in a sample of neonatal cadavers. RESULTS: In 39 neonatal cadavers, the mean distance from the apex of the sacral hiatus to the dural sac was 10.45 mm. The range of this distance was between 4.94 and 26.28 mm. The mean distance for females was 9.64 mm (range from 6.66 to 15.09); that for males was 10.90 mm (range between 4.94 and 26.28). Linear regression with the log of this distance as the outcome variable gave an estimated 3.3% increase in the distance for each 1 cm increase in the length of the neonate (95% CI for this proportion was 1.91-4.71). CONCLUSION: Anesthesiologists should be aware of the short distance between the sacral hiatus and the dural sac when performing caudal blocks, the shortest distance was 4.94 mm. Armed with this knowledge, caudal techniques should be modified to improve the safety and reduce the risk of complications, such as dural puncture.