{"id":925,"date":"2017-10-01T15:00:24","date_gmt":"2017-10-01T15:00:24","guid":{"rendered":"http:\/\/www.ijmhr.org\/IntJAnatRes\/?page_id=925"},"modified":"2017-10-01T15:06:04","modified_gmt":"2017-10-01T15:06:04","slug":"ijar-2017-382","status":"publish","type":"page","link":"https:\/\/www.ijmhr.org\/IntJAnatRes\/ijar-2017-382","title":{"rendered":"IJAR.2017.382"},"content":{"rendered":"
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Type of Article:<\/strong>\u00a0\u00a0Original Research<\/h3>\n

Volume 5; Issue 4.1 (October 2017)<\/strong><\/h3>\n

Page No.:<\/strong>\u00a04492-4499<\/h3>\n

DOI:\u00a0<\/strong>https:\/\/dx.doi.org\/10.16965\/ijar.2017.382<\/h3>\n

UNRAVELLING THE MYSTERY BEHIND SUCCESSFUL CAUDAL-EPIDURAL BLOCK<\/h3>\n

Subhra Mandal *1<\/sup>, Moumita Saha 2<\/sup>, Shirshendu Ganguly 3<\/sup>, Manjari Chatterjee 4<\/sup>, Prabir Mandal 5<\/sup>, Ramprasad Saha 6<\/sup>.<\/strong><\/p>\n

*1<\/sup> Associate Professor, Department of Anatomy, Medical College, Kolkata, West Bengal, India.<\/p>\n

2<\/sup> Senior Resident, Anatomy, R.G. Kar Medical College, Kolkata, West Bengal, India.<\/p>\n

3<\/sup> Demonstrator, Anatomy, Medical College, Kolkata, West Bengal, India.<\/p>\n

4<\/sup> Retired Professor and Head, Department of Anatomy, Medical College, Kolkata, West Bengal, India.<\/p>\n

5<\/sup> Medical Officer, Bangur Hospital, Kolkata, West Bengal, India.<\/p>\n

6<\/sup> Final Year M.D. P.G.T. (Paediatrics), R.G. Kar Medical College, Kolkata, West Bengal, India.<\/p>\n

Address for Correspondence: <\/strong>Dr.(Mrs) Subhra Mandal, Associate Professor, Department\u00a0 of Anatomy, Medical College & Hospital, Kolkata, West Bengal, India. Cont No.- 9477458100\/9830814744 E-Mail:<\/strong> drsuvramandal@gmail.com<\/p>\n

ABSTRACT<\/strong><\/p>\n

Introduction:<\/strong> The caudal epidural anaesthesia or block (CEB) is a process where special medications are injected into epidural space to provide analgesia and anaesthesia in various clinical procedures.CEB has been widely used for the treatment of lumbar spinal disorders, conservative management of chronic back pain as well as for providing anaesthesia in obstetrics .Successful CEB depends on precise localisation of sacral hiatus (SH),through which we gain access to sacral epidural space for effective block of sacral nerves. Anatomically sacral hiatus indicates termination of sacral canal resulting from failure of fusion of lamina of 5th<\/sup> sacral vertebra. It is utmost essential to have clear concept about anatomical variations associated with sacral hiatus so that success of CEB is guaranteed.<\/p>\n

Aim:<\/strong> To study the morphometry of sacral hiatus as well as anatomical variations related to it that is useful for successful caudal epidural block.<\/p>\n

Materials and methods:<\/strong> Present study was carried out on 191 dry human sacra (West Bengal, Indian population) to record various anatomical landmarks of sacral hiatus.<\/p>\n

Result:<\/strong> Various shapes of sacral hiatus were recorded which included-Inverted U (46.84%) , Inverted V(38.42%),Irregular(11.58%),Dumb-bell(3.16%) and Agenesis of SH(1case). The Apex of sacral hiatus was most commonly found at the level of 4th<\/sup> sacral vertebra in 60% specimens and base of SH was present opposite the body of 5th<\/sup> sacral vertebra in 76.32% cases .Also, 82.63% specimen had mean length of sacral hiatus in between1to 2 cm. The anteroposterior diameter of sacral canal measured at the apex of SH was 0.4 to 0.6 cm in 68.95% cases .The width at the base of sacral hiatus most commonly (80.52%) ranged between more than1 to 2 cm in our study.<\/p>\n

Conclusion:<\/strong> Acknowledging the broad spectrum of clinical implications of caudal epidural block,it\u2019s very important to identify the precise location of sacral hiatus and caudal epidural space. Discrepancies in size and shape of SH, neighbouring bony irregularities and occasional defects in the dorsal wall of sacral canal should be thoroughly considered before performing CEB ,so that inadvertent dural sac puncture is avoided and surrounding essential structures are not injured. Instead of using conventional blind technique, newer fluoroscopy or ultrasound guided needle placement has markedly improved the success rate of CEB.<\/p>\n

Key words:<\/strong> Sacral hiatus (SH), Caudal epidural block (CEB), Sacral canal, Dural sac, Fluoroscopy.<\/p>\n

REFERENCES<\/strong><\/p>\n

    \n
  1. Standring S,\u201dThe Back\u201d in Gray\u2019s Anatomy:The Anatomical Basis of Clinical Practice.40th<\/sup> edition, Elsevier Churchill Livingstone, London, 2013;724-5.<\/li>\n
  2. Williams,PL.Gray\u2019s Anatomy.38th<\/sup> Churchill Livingstone,2000;530(1):673-674.<\/li>\n
  3. Waldman SD.Caudal epidural nerve block:prone position. Atlas of Interventional Pain Management, 2nd<\/sup> Philadelphia: Saunders, 2004:380-92.<\/li>\n
  4. Sekiguchi M,Yabuki S,Satoh K,Kikuchi S.An anatomic study of sacral hiatus: a basis for successful caudal epidural block .Clin J Pain 2004;20:51-4.<\/li>\n
  5. Aggarwal A ,Aggarwal A , Harjeet, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block.Surgical and Radiological Anatomy 2009;31(10):739-800.<\/li>\n
  6. Sicard JA. Les injections medicamenteuse extraduraqles per voie saracoccygiene.Comptes Renues des Senances de la Societe de Biolgie et de ses Filliales,1901;53:396-398.<\/li>\n
  7. Cathelin F.Mode d\u2019action de a cocaine injete dausl escapte epidural par le procede du canal sacre.Comptes Renues des Senances de la Societe de Biolgie et de ses Filliales,1901;53:452-453.<\/li>\n
  8. Martinez Curbelo M. Continuous Peridural segmental Anesthesia by means of a urethral catheter.Curr Res Anesth Analg. .1949;28:13-23(PUBMED)<\/li>\n
  9. Bentley A.,Ogoke MD. Caudal Epidural Steroid Injections.Pain Physician. 2000;3(3):305-312.<\/li>\n
  10. Chen PC, Tang SFT, Hsu TC et al.Ultrasound guidance in caudal epidural needle placement. Anaesthesiology 2004;101:181-4.<\/li>\n
  11. Nagar SK. A study of sacral hiatus in dry human sacra. J Anat Soc India.2004;53(2):18-21.<\/li>\n
  12. Trotter M and Letterman GS.Variations of the female sacrum: Their significance in continuous caudal analgesia. Surgery, Gynaecology and Obstetrics. 1944;78(4):419-424.<\/li>\n
  13. Kumar V.,Pandey ,Bajpai\u00a0\u00a0 RN.,Jain PN.and Longia\u00a0 GS. Morphometric study of sacral hiatus. Journal of Anatomical Society of India, 1992;47(1):7-13.<\/li>\n
  14. Patel DK et al. Multicentric\u00a0 Morphometric\u00a0 study of Dry Human Sacrum of Indian Population in Gujrat Region. NJIRM 2011;2(2):31-35.<\/li>\n
  15. Seema Singh M and Mahajan A. An Anatomical Study of Variations of Sacral Hiatus in Sacra of North Indian Origin and its Clinical Significance. Int. J Morphol.2013;31(1):110-114.<\/li>\n
  16. Jadhav Mayuri, Nikam Vasudha, Ghorpade Vijay, Gune Anita, Patil Asha. Anatomical Study of Sacral Hiatus in Dry Isolated Sacra.Journal of Research in Medical and Dental Science. 2014;2(2):43-6.<\/li>\n
  17. Trotter M. and Lanier PF. Hiatus Canalis Sacralis in American Whites and Negros. Human Biology, 1945;17:368-381.<\/li>\n
  18. Trotter M. Variations of the sacral canal: Their significance in the administration of caudal analgesia. Anaesthesia and Analgesia .1947;26(5):192-202.<\/li>\n<\/ol>\n

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    \n \t Cite this article:<\/strong><\/span> Subhra Mandal, Moumita Saha, Shirshendu Ganguly, Manjari Chatterjee, Prabir Mandal, Ramprasad Saha. UNRAVELLING THE MYSTERY BEHIND SUCCESSFUL CAUDAL-EPIDURAL BLOCK. Int J Anat Res 2017;5(4.1):4492-4499. DOI:\u00a0<\/strong>10.16965\/ijar.2017.382\u00a0 \n <\/div>\t\n\t\t\n","protected":false},"excerpt":{"rendered":"

    Type of Article:\u00a0\u00a0Original Research Volume 5; Issue 4.1 (October 2017) Page No.:\u00a04492-4499 DOI:\u00a0https:\/\/dx.doi.org\/10.16965\/ijar.2017.382 UNRAVELLING THE MYSTERY BEHIND SUCCESSFUL CAUDAL-EPIDURAL BLOCK Subhra Mandal *1, Moumita Saha 2, Shirshendu Ganguly 3, Manjari Chatterjee 4, Prabir Mandal 5, Ramprasad Saha 6. *1 Associate Professor, Department of Anatomy, Medical College, Kolkata, West Bengal, India. 2 Senior Resident, Anatomy, R.G.
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