Anatomic consideration of caudal epidural space: a cadaver study

Area of Science:

• Anatomy
• Anesthesiology
• Pain Management

Background:

• Accurate knowledge of sacral hiatus anatomy is vital for successful caudal epidural blocks.
• Potential complications include procedure failure and dural injury.

Purpose of the Study:

• To conduct a detailed anatomical study of the sacral region in adult Indian cadavers.
• To identify key landmarks and measurements for safe caudal epidural block needle insertion.

Main Methods:

• Dissection of the dorsal sacral region in 49 male adult Indian cadavers.
• Measurement of sacral hiatus dimensions, sacrococcygeal ligament length, and related anatomical triangles.
• Assessment of cornu palpability and needle insertion angle/depth parameters.

Main Results:

• Varied palpability of sacral cornua (bilaterally absent in 14.3%, unilaterally present in 24.5%).
• Mean distance from hiatus apex to coccyx tip: 57.5 mm; sacrococcygeal ligament length: 34.2 mm.
• Dural sac termination at S2 in 83.6% and maximum sacral curvature at S3 in 69.4%.

Conclusions:

• Precise anatomical measurements of the sacral hiatus aid in identifying the correct insertion point.
• Optimal needle angle (mean 65.7°) and limited advancement (<5 mm beyond ligament) are critical for preventing dural puncture.
• These findings enhance the safety and reliability of caudal epidural blocks for lumbosacral spine procedures.