The Volume of the Caudal Space and Sacral Canal in Human Sacrum

Asghar, Adil; Naaz, Shagufta

doi:10.7860/jcdr/2013/6287.3724

Cited by 9 publications

(15 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An early anatomical study, which was conducted by Lanier and Trotter [60], suggested that the volume of sacral canal in a European population using rising of fluid in the vertebral column was slightly more than 30 mL (range from 12 to 65 mL). In a recent study, the mean recorded volume of the sacral canal in an Indian population sample was 38.26 mL (range from 23.67 to 62.78 mL) [6].…”

Section: Variations In the Morphology Of The Sacral Canal -Complete Dmentioning

confidence: 94%

“…The diameter of the sacral canal is less than 2 mm in 1% of sacral bones, thus inhibiting the use of 22 G needles [100]. In addition, the available caudal epidural space volume must be estimated preoperatively, so that high block complications are avoided [6]. Ultrasound is a safe, non-invasive and simple method of examination of the exact sacral anatomy, identification of sacral variations and accurate estimation of the volume of epidural space [1].…”

Section: Clinical Significance In Anaesthesiologymentioning

confidence: 99%

See 1 more Smart Citation

Anatomy and clinical significance of sacral variations: a systematic review

et al. 2019

View full text Add to dashboard Cite

The sacrum is a large trilateral bone located at the base of the vertebral column serving to transfer the body weight from the trunk to the pelvis and lower extremities. Over the years, an abundance of sacral anatomical divergences has been reported, including numerical and/or morphological variations of sacral entities. The majority of these anatomical alternations has been incidentally identified during radiological investigations, surgical procedures or discovered in anatomical, anthropological and forensic research studies. Throughout international literature, however, there is a scarcity of an integrative recording of all known anatomical variations of the sacrum in a single study. This constitutes the objective of the present paper: to provide an exhaustive systematic review of the relevant literature, as well as to thoroughly describe all the recognised deviations of the sacrum structure, while highlighting the aspects of their clinical significance. (Folia Morphol 2019; 78, 4: 651-667)

show abstract

Section: Variations In the Morphology Of The Sacral Canal -Complete Dmentioning

confidence: 94%

Section: Clinical Significance In Anaesthesiologymentioning

confidence: 99%

Anatomy and clinical significance of sacral variations: a systematic review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In both sexes combined, the mean volume of the entire vertebral canal is 38.3 cm 3 and the mean volume of the caudal space is 14.3 cm 3 according to Asghar and Naaz (2013). Both these mean values were significantly larger in males than females.…”

Section: Discussionmentioning

confidence: 98%

“…It has a pyramidal shape and consists of five embryonic fused vertebrae. The coccyx consists of three to five rudimentary vertebrae and is triangular, with its base attached to the sacrum (Asghar & Naaz, 2013). The sacrum has a dorsal convexity but is highly variable in size and shape.…”

Section: Discussionmentioning

confidence: 99%

“…Caudal epidural anesthetic blocks are widely used in intra‐operative and post‐operative analgesia for a variety of operations (e.g., genitourinary surgery) and labor pain, as well as management of chronic low back pain (Asghar & Naaz, 2013; Bagheri & Govsa, 2017). In the setting of caudal blocks, an inadvertent intradural positioning of the needle tip is the primary complication of the procedure rather than the goal (Jones et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Imaging anatomy of the vertebral canal for trans‐sacral hiatus puncture of the lumbar cistern

2020

View full text Add to dashboard Cite

A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral hiatus prompted us to test if image‐guided percutaneous trans‐sacral hiatus access to the lumbosacral subarachnoid cistern would be anatomically feasible. To study vertebral canal morphometry and curvature, we analyzed midsagittal computed tomography‐myelogram images of 40 normal subjects and digitally measured sacral curvatures between S1 to S5 and S2 to S4 using two methods whereby a lower angle signifies a straighter sacrum. We measured midsagittal vertebral canal area, hiatus width, dural sac termination levels, and distance from sacral hiatus to the dural sac tip (needle distance). Subjects were F:M = 25:15, with a mean age of 44.9 years. The two S1–S5 full sacral curvature mean angles were 57.3° and 60.4°. Almost all sacral hiatuses were at S4, and dural sac terminations were at S1–S2. The mean S2–S4 sacral curvature was 25.1°, and the mean needle distance was 57.7 mm. Using two‐way analysis of variance, there were significant sex differences for needle distances (p = .001), and full and limited sacral curvatures (p = .02, and p = .046, respectively). There were no significant linear regression correlations between age and sacral curvature, needle distance, canal area, or hiatus width. Therefore, despite a frequently prominent full sacral curvature, the combination of S1–S2 dural sac termination plus a relatively straight trajectory of the lower vertebral canal between S2 and S4 support the theoretical feasibility of percutaneous trans‐sacral hiatus and vertebral canal access to the lumbosacral cistern using a standard spinal needle.

show abstract

The Minimum Effective Concentration (MEC95) of different volumes of ropivacaine for ultrasound-guided caudal epidural block: a dose-finding study

Chen

et al. 2023

BMC Anesthesiol

View full text Add to dashboard Cite

Background Caudal epidural block (CEB) may be beneficial in anorectal surgery because its use may extend postoperative analgesia. This dose-finding study aimed to estimate the minimum effective anesthetic concentrations for 95% patients(MEC95) of 20 ml or 25 ml of ropivacaine in with CEB. Patients and methods In this double-blind, prospective study, the concentration of ropivacaine administered in 20 ml and 25 ml for ultrasound-guided CEB were determined using the sample up-and-down sequential allocation study design of binary response variables. The first participant was given 0.5% ropivacaine. Depending on whether a block was successful or unsuccessful, the concentration of local anesthesia was decreased or increased by 0.025% in the next patient. Every five minutes for 30 min, the sensory blockade using a pin-prick sensation at S3 dermatome compared to at T6 dermatome were evaluated every 5 min within 30 min. An effective CEB was defined as a a reduction of sensation at S3 dermatome and the existence of flaccid anal sphincter. Anesthesia was considered successful if the surgeon could perform the surgery without additional anesthesia. We determined the MEC50 using the Dixon and Massey up-and-down method and estimated the MEC95 using probit regression. Results The concentration of ropivacaine administered in 20 ml for CEB ranged from 0.2% to 0.5%. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC 50 of ropivacaine for anorectal surgical anesthesia were 0.27% (95% CI, 0.24 to 0.31) and 0.36%(95% CI, 0.32 to 0.61). The concentration of ropivacaine administered in 25 ml for CEB ranged from 0.175 to 0.5. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC95 for CEB were 0.24% (95% CI, 0.19 to 0.27) and 0.32% (95% CI, 0.28 to 0.54). Conclusion With ultrasound-guided CEB, the MEC95 of 0.36% ropivacaine at 20 ml and 0.32% ropivacaine at 25 ml provide adequate surgical anesthesia/analgesia 95% of patients undergoing anorectoal surgery. Trial registration Clinicaltrails.gov: Retrospectively registered (ChiCTR2100042954; Registration date:1/2, 2021).

show abstract

The Volume of the Caudal Space and Sacral Canal in Human Sacrum

Abstract: Introduction: Caudal block is now-a -days a commonly used procedure for pain management and regional anaesthesia. The optimum volume of drugs required to reach the appropriate level is needed.

Cited by 9 publications

References 6 publications

Anatomy and clinical significance of sacral variations: a systematic review

Anatomy and clinical significance of sacral variations: a systematic review

Imaging anatomy of the vertebral canal for trans‐sacral hiatus puncture of the lumbar cistern

The Minimum Effective Concentration (MEC95) of different volumes of ropivacaine for ultrasound-guided caudal epidural block: a dose-finding study

Contact Info

Product

Resources

About