Figure RA.22 Needle angulation for caudal anaesthesia


Block height

Volume in ml/kg





Mid thoracic

for 3-4 hours compared with 6-8 hours for bupivacaine.

Adults: 25-30 ml 0.5% bupivacaine provides 6-8 hours of sub umbilical analgesia with a variable degree of segmental spread and motor blockade. If analgesia is necessary only within the sacral nerves, 20 ml is sufficient.


Incorrect needle placement is the commonest problem of the technique and is usually a matter of difficulty palpating landmarks. If the needle is too superficial, then the only adverse effect is a subcutaneous injection and a failed block. If the needle is inserted too deeply, it can pass through the sacrococcygeal joint into the pelvic cavity and thus the viscera, risking contamination of the epidural space. In pregnant patients there are reports of the needle entering the birth canal and damaging the foetal head. Intravascular injection is a risk due to the rich plexus of veins within the sacral canal. If the marrow of the sacral vertebra is cannulated and the dose injected, rapid systemic absorption can occur. Infection from a dirty technique in a potentially unsterile area is a constant risk. Dural puncture is an uncommon but important complication because of the potentially large volume of local anaesthetic solution that can be inadvertently injected intrathecally.

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