Abstract
The study was designed to quantify the hit/miss ratio of non-radiologically assisted caudal epidurals, assessing both accuracy of entry into the epidural space and adequacy flow of contrast and therapeutic agents to the level of pre-defined pathology.
We studied 146 consecutive patients listed for a caudal epidural under sedation for either radicular pain or spinal stenosis. When the surgeon was happy with placement of the needle its position was assessed using image intensifier and injection of radio-opaque dye (Omnipaque). The epidurogram was also used to confirm the level of pathology had been reached by the steroid and local anaesthetic.
Three patients were excluded because of inadequate records. Five patients did not attend for their procedure. Of the remaining 138 patients Consultant spinal surgeons carried out 75 procedures and the remaining 63 cases were performed by “middle grade” surgeons. 36 of 138 patients (26%) had placement of spinal needle outside the epidural space after first blind placement. Hit rate was not related to surgeon grade, patient age or patient diagnosis. In 6% of cases the radio-opaque dye did not reach the level of documented pathology had been reached by the dye. 2 patients had a “spinal” pattern of block requiring overnight admission, there were no other complications recorded.
A miss rate of 26% in the blind placement of spinal needles through the sacral hiatus in caudal epidurals is unacceptable. We would therefore recommend position of the needle is confirmed radiologically and epidurogram is used to confirm accurate delivery of the therapeutic agents.
Interest statement: none
Ethics approval: none (study of current practice)
Correspondence should be addressed to BASS/BCSS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
