Since Sicard, Cathlin and Tuffier performed the first sacral extradural anesthetic technique in 1901, surprisingly increased interest in this technique and basic investigation has been done concerning the anatomy, the physiology, and the fate of the local anesthetic in the body, after in jection in the epidural space. Recently, a decreasing interest in peridural anesthesia and nerve block thechniques have resulted from the availability of more efficacious and more safe volatile anesthetics. However in case of contraindication of both general and spinal anesthesia, this caudal anesthesia should be available and very usefull. Authers have undertaken to evaluate the circulatory effect of caudal anesthesia with the injection of lidocain into the epidural space through the sacral hiatus. Ten cases were selected and observed the change of the cardiovascular system before and after caudal anesthesia. The changes of the heart rate and systolic blood pressure between pre-and post anesthesia were insignificant statistically.
Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, Spinal ; Anesthetics ; Blood Pressure ; Cardiovascular System ; Epidural Space ; Heart Rate ; Lidocaine* ; Nerve Block ; Physiology

The changes of onset and duration of caudal epidural anesthesia had been compared in 54 patients schedulled for perianal surgery at kyungpook National University HospitoL The patients were divided into 3 groups of 18: lidocaine group received 2% lidocaine 20 ml, mixture group received 2% lidocaine 10 ml and 0.5% bupivacaine 10 ml and bupivcaaine group received 0.5% bupivacaine 20 ml. The onsets were as follows. The onsets wiere 3.11+/-0.63 in lidocaine group, 4.83+/-4.17 in mixture group and 8.13+/-3.49 min in bupivacaine group. The onset of bupivacaine group was slower than lidocaine group(p<0.01) and late compared with mixture group(p<0.5). The duration of caudal anesthesia were 192.00+/-62.49 in lidocaine group, 326.72+/-145.28 in mixture group and 419.22+/-125.37min in bupivacaine group. Significant differences were observed between mixture-lidocaine group(p<0.01), bupivacaine-lidocaine group(p<0.01) and bupivacaine-mixture group(p<0.05). Urinary catheteiized patients were 8 in longest duration group of bupivacaine. It is suggested from the above'results that the mixture of lidocaine and bupivacaine during caudal epidural anesthesia can produce rapid onset and long duration.
Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthetics, Local* ; Bupivacaine ; Gyeongsangbuk-do ; Humans ; Lidocaine

From September 1979 through April 1980, we had carried out continuous lumbar epidural anesthesia(2% lidocaine, 20ml) with small dose of morphine and single dose caudal anesthesia(2% lidocaine, 15-20ml) for 16 cases of lumbar laminectomy,And also we observed the effects of postanesthetic pain relief by administered morphine(2mg) into lumbar epidural space, The results of this study were as follows: 1) Age distribution was from 20 to 60 years, sex distribution was 14 in man and 2 in woman, and physical status was in ASA class I in all cases. 2) The site of herniated intervertebral disc was L4~5 in 15 cases and L3~4 in one, The epidural puncture site was selected 2~3 vertebral segments cephalad from the lesion, 3) The morphine amount administered with lidocaine into lumbar epidural space was 2mg in all cases. 4) The duration of pain relief from the induction of anesthesia was average 17. 5 hours, and from the additional epidural injection of morphine(2mg) in ward was average 13.5 hours. 5) There was no neurological deficit or sequele except nausea in one case postoperatively. Therefore this anesthetic method was not only satisfactory for laminectomy but also safer and simpler in the fixation of spinal anesthetic level by patient's position change than spinal anesthesia, and faster in the postanesthetic ambulation than general anesthesia. Moreover, surgeon's acceptability.
Age Distribution ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, General ; Anesthesia, Spinal ; Epidural Space ; Female ; Humans ; Injections, Epidural ; Intervertebral Disc ; Laminectomy* ; Lidocaine ; Methods ; Morphine* ; Nausea ; Punctures ; Sex Distribution ; Walking

BACKGROUND: The advantages of addition of epinephrine to local anesthetics during caudal epidural anesthesia are core intense block, prolonged duration of anesthesia and reduction of systemic toxic effect of local anesthetics. The currently recommended concentration of epinephrine is 1 : 200,000, but absorbed epinephrines cause unwanted hemodynamic changes, so we attempted to ascertain the minimum effective concentrations of epinephrine during caudal epidural anesthesia. METHODS: Ninty patients classified ASA physical status I or II scheduled for perianal surgery were studied. These patients were divided into four groups who received 20 ml of 2% lidocaine with epinephrine concentrations of 1 : 100,000, 1 : 200,000, 1 : 400,000 or 1 : 800,000 respectively. Before and during anesthesia, patients' mean arterial pressure (MAP) and heart rate (HR) were measured. Caudal anesthesia was performed with patients in the jack-knife position. A 3 ml test dose was administered initially and then the remaining local anesthetics were injected slowly. The onset of analgesia, duration of analgesia, and other complications were observed. RESULTS: The onset of analgesia was slowest in the 1 : 800,000 group. The duration of analgesia was longest in the 1 : 100,000 group. There were no significant difference in MAP changes, but HR increased significantly in the 1 : 100,000 group compared to the 1 : 200,00 group. There were no systemic toxic symptoms for local anesthetics except that 1 patient, who was in the 1 : 100,000 group, had symptoms of palpitation and headache, considered to be the unwanted pharmacologic effects of epinephrine. CONCLUSION: We concluded that the 1 : 400,000 epinephrine concentration can be used during caudal epidural anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Caudal ; Anesthesia, Epidural* ; Anesthetics, Local ; Arterial Pressure ; Epinephrine* ; Headache ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine

BACKGROUND: We investigated the value of using contrast as an additional aid to confirm the accuracy of needle placement for caudal epidural injections under intraoperative image intensifier guidance. METHODS: A total of 252 consecutive patients were included in this study. Their mean age was 46.7 years (range, 32 to 76 years). There were 133 males (53%) and 119 females (47%) over a 12-month period. RESULTS: Of the 252 consecutive procedures, the contrast enhanced image intensifier confirmed accurate needle placement on first attempt in 252 cases (100%). Needle resiting following the infiltration of contrast was required in 0 case. CONCLUSIONS: The results from this study demonstrate that a surgeon beyond the learning curve can accurately place caudal epidural injections using image intensification only, without the use of contrast.
Anesthesia, Caudal ; Female ; Fluoroscopy ; Humans ; Injections, Epidural* ; Learning Curve ; Male ; Needles ; Spine

No abstract available.
Anesthesia, Epidural*

OBJECTIVE: To determine that epidural anesthesia need not increase Cesarean delivery rates and prolong labor. METHODS: From December 1999 to May 2002, 1,585 deliveries were in Ilsan Paik Hospital. We selected 70 (epidural group) and 87 (non-epidural group) singleton, nulliparous, term, cephalic presentation without antenatal complications. We compared duration of labor, rates of Cesarean delivery and perinatal outcomes between these two groups. RESULTS: The duration of active and second stage of labor were not prolonged in the epidural group. Cesarean delivery rates was 8.6% (n=70) in the epidural group and 9.2% (n=87) in the non-epidural group, so there was no significant difference. Perinatal outcomes was no significant difference between the two groups. CONCLUSION: Epidural anesthesia during labor provides the best pain relief and does not increase the Cesarean delivery rates. The duration of the active, second stage of labor and perinatal outcomes was not different between these two groups.
Anesthesia, Epidural*

The caudal epidural anesthesia has been popular due to the postoperative pain relief and the reduction of the amount of general anesthetics. It is also technically simple and safe both for inpatients and outpatients under the age of 7 Year. The aim of this study was to determine the adequate dosage and degree of postoperative pain relief according to the different local anesthetics. We have performed the caudal anesthesia in 60 patients from the age of 10 month to 7 year. All caudal blocks were performed under light general anesthesia in order to relief the fear and anxiety of operation. The patients were divided by 4 groups of each 15 children. Group 1 (control group) for 1% lidocaine 1 ml/kg, Group 2 for 1% lidocaine 0.8 ml/kg, Group 3 for 0.25% bupivacaine 0.8 ml/kg, Group 4 for 0.25% bupivacaine 0.6 ml/kg. All groups were given 1:200,000 epinephrine. The overall success rate of caudal blocks was 98%. Complication was 3 cases. As the result of this study, Group 1 (control group): There was sensory block over T4 (20%). The degree of motor block was very high(73.3%). Group 2 and 3: There was no sensory block over T4. Duration of postoperative analgesia was long enough compared to the control group (p<0.05). The degree of motor block was less than the control group. Group 4: The height of most sensory block was below T8 (80%). The degree of motor block was very low (p<0.05) and duration of postoperative analgesia was short compared to the control group (p<0.001). Therefore it is considered that caudal blocks in Group 2 & 3 were adequate dosage for the pediatric operation.
Analgesia ; Anesthesia, Caudal* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics, General ; Anesthetics, Local ; Anxiety ; Bupivacaine ; Child ; Epinephrine ; Humans ; Inpatients ; Lidocaine ; Outpatients ; Pain, Postoperative*

Epidural and intrathecal injection of narcotics for postoperative pain relief have been well reported. In an attempt to assess the postoperative analgesic effect of demerol in anal surgery, caudal block was carried out with 1.5% lidocaine mixed with demerol 5 mg(Group II) in 15 patients and demerol 1 0 mg(Group II) in 15 patients. As a control group(Group I), 16 patients were injected with 1.5% lidocaine alone in the epidural space for caudal anesthesia. The incidence of postoperative injection of demerol as needed by the patients for pain control were recorded and compared. As a result of this study, the 3rd group in which 10 mg of demerol were used, appeared to have a significantly prolonged analgesic effect and there were no serious complications observed in our experience such as nausea, vomiting or respiratory depression.
Anesthesia, Caudal ; Epidural Space ; Humans ; Incidence ; Injections, Spinal ; Lidocaine ; Meperidine* ; Narcotics ; Nausea ; Pain, Postoperative ; Respiratory Insufficiency ; Vomiting

BACKGROUND: Caudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle on the success rate of caudal epidural blocks. METHODS: A total of 49 adults scheduled to receive caudal epidural injections were randomly divided into 2 groups: Group 1 to receive the caudal injection through a conventional method, i.e., caudal injection after advancement of the needle 1 cm into the sacral canal (n = 25), and Group 2 to receive the injection through a new method, i.e., injection right after penetrating the sacrococcygeal ligament (n = 24). Ultrasound was used to identify the sacral hiatus and to achieve accurate needle placement according to the allocated groups. Contrast dyed fluoroscopy was obtained to evaluate the epidural spread of injected materials and to monitor the possible complications. RESULTS: The success rates of the caudal injections were 68.0% in Group 1 and 95.8% in Group 2 (P = 0.023). The incidences of intravascular injections were 24.0% in Group 1 and 0% in Group 2 (P = 0.022). No intrathecal injection was found in either of the two groups. CONCLUSIONS: The new caudal epidural injection technique tested in this study is a reliable alternative, with a higher success rate and lower risk of accidental intravascular injection than the conventional technique.
Adult ; Anesthesia, Caudal ; Fluoroscopy ; Humans ; Incidence ; Injections, Epidural ; Injections, Spinal ; Ligaments ; Low Back Pain ; Needles* ; Prospective Studies ; Punctures ; Radiculopathy ; Ultrasonography