Ultrasound-Guided Caudal Epidural Anesthesia in Adults for Anorectal Procedures

Caudal epidural is a commonly performed regional anesthetic technique in children. In adults, the high-failure rates associated with landmark-based techniques deter its widespread use. Fluoroscopy-guided caudal epidural steroid injections are widely used as a treatment modality in chronic back pain. Ultrasound (US) guidance has been shown to be equally effective as fluoroscopic-guided caudal injections. We aimed to assess the feasibility of US guided caudal epidurals as a sole anesthesia technique in adult patients undergoing minor anorectal procedures.

Fifty consecutive adult patients undergoing elective minor anorectal procedures were recruited for this study. Eligible patients received US-guided caudal epidural and success rates, surgical patient and surgeon's comfort were assessed using validated tools. Any adverse events were also observed.

The block was successful in all patients. One patient had pain in the perianal region requiring skin infiltration. All patients were either highly satisfied or satisfied of the procedure. Surgeons rated the surgical conditions as highly satisfied (90%), satisfied (8%), or unsatisfied (2%). Two patients rated the caudal injections were of moderate pain, rest all rated it as mildly painful. One patient experienced a single episode of urinary incontinence.

US-guided caudal epidural can be considered as an option for anorectal procedures of short duration with acceptable success rates, surgical conditions, and patient comfort.