What Are the Pros and Cons of a Caudal Block?

A caudal block is a local anesthetic procedure that numbs the lower back in the spinal column along the sacrum. The procedure is performed by injecting a combination of Bupivacaine and Lidocaine into the caudal end of the spinal column. Besides the initial concern of a syringe injection into the sensitive spinal canal, risks of the procedure include postoperative apnoea in young children, an allergic reaction to the anesthesia, puncture of the rectum or the durum, and infection from the injection process. These risks are rare though, and when compared to the benefits of the procedure, the caudal block technique remains one of the most common and successful methods of anesthesia.

Though the reasons vary, this procedure is generally performed in very young children undergoing subumbilical surgery, or surgery in the lower abdominal region below the navel. The caudal epidural block procedure is also performed in pregnant women to relieve pain during childbirth. Anesthetic completely numbs the nerves, relieving pain and enabling the surgical procedure.

The caudal block is given under a fluoroscopic x-ray to ensure exact placement of the needle in the caudal area. On rare occasions, the needle can puncture the dural lining of the spinal cord. This can cause hypotension or apnea. Infection may follow the procedure if the instruments and skin surface have not been properly sanitized or if the needle punctures the rectum.

Some patients are allergic to the drugs commonly used in the caudal block procedure and may experience a severe reaction. Typical allergic reactions include itching, rash, hematoma, difficulty breathing, heart rate fluctuations and unconsciousness. Some patients may experience occasional sensations of pain after the caudal block effects have worn off. These are called "flares" and eventually subside over time.

The most obvious advantage to the caudal block is that it relieves pain without general anesthesia. Risks that are associated with general anesthesia are higher than those of local anesthesia. The dangers of the anesthesia rise in young children given both general anesthesia and a caudal block. To minimize the risks of pediatric postoperative apnoea, surgeons may elect to sedate the child in place of general anesthesia.

Done carefully and by an experienced medical professional, a caudal block is a safe procedure that eliminates the need for the more invasive and complex general anesthesia. Complications are rare. This is one of the most common anesthetic methods for surgery on children and is an effective means for treating back pain and childbirth pain.