Sacral hiatus anatomical variations and clinical relevance in caudal epidural block
Keywords:
sacrum, sacral canal, sacral hiatus, caudal epidura block, sacral cornuAbstract
Objective: For the management of perioperative pain control during procedures like genitourinary surgery and labor pain instances when the sacral epidural space technique is utilized for the application of analgesia, caudal epidural anesthesia (CEB) is frequently used. CEB is an anesthetic that is injected through the sacral hiatus (SH) into the sacral canal. Anatomical features of sacral hiatus that are in-depth are needed for the best possible access to the sacral epidural area. By employing the sacral bone as a point of reference to failure parameters for evaluating caudal epidural anesthesia and refining the success factors in practice, this study intends to explore the anatomical structures and variations of the Sacral hiatus. Material and methods: 85 sacral bones had their alignment points measured precisely morphometrically. Virtual calipers were used to take the readings were used to evaluate those utilizing photogrammetric techniques. Results: Inverted U was the most frequent sacral hiatus form reported (33.32%), although bifida and 6.8% 3.44% of cases frequently missing sacral hiatus were also seen. The mean Sacral hiatus length was 28.67.0 mm, the mean intracorneal distance was 13.472.68 mm, and the mean gap between the apex of the Sacral hiatus and S2 sacral foramen was 34.677.08 mm.
Downloads
References
Abukawa Y, Hiroki K, Morioka N, Iwakiri H, Fukada T, Higuchi H, Ozaki M. 首页» 文章» 文章详细信息. BMC Anesthesiology. 2015 Jul 14;15(1).
Aggarwal A, Aggarwal A, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block. Surgical and radiologic anatomy. 2009 Dec;31(10):793-800.
Aggarwal A, Kaur H, Batra YK, Aggarwal AK, Rajeev S, Sahni D. Anatomic consideration of caudal epidural space: a cadaver study. Clinical Anatomy. 2009 Sep;22(6):730-7.
AmirMohajerani S. Ultrasound as a Screening Tool for Performing Caudal Epidural Injections. Iranian Journal of Radiology.;11(2).
Black MG. Anatomic reasons for caudal anesthesia failure. Anesthesia & Analgesia. 1949 Jan 1;28(1):33-9.
Bush KE, Hillier S. A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine. 1991 May 1;16(5):572-5.
Busoni P, Sarti A. Sacral intervertebral epidural block. The Journal of the American Society of Anesthesiologists. 1987 Dec 1;67(6):993-4.
Chen CP, Tang SF, Hsu TC, Tsai WC, Liu HP, Chen MJ, Date E, Lew HL. Ultrasound guidance in caudal epidural needle placement. The Journal of the American Society of Anesthesiologists. 2004 Jul 1;101(1):181-4.
Cicekcibasi AE, Borazan H, Arıcan S, Yılmaz MT, Sakarya ME. Where is the apex of the sacral hiatus for caudal epidural block in the pediatric population? A radio-anatomic study. Journal of anesthesia. 2014 Aug;28(4):569-75.
Crighton IM, Barry BP, Hobbs GJ. A study of the anatomy of the caudal space using magnetic resonance imaging. British journal of anaesthesia. 1997 Apr 1;78(4):391-5.
Cuckler JM, Bernini P, Wiesel SW, Booth Jr RE, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. The Journal of bone and joint surgery. American volume. 1985 Jan 1;67(1):63-6.
Holinshed WH. Anatomy for surgeons: vol. 3 (The Back and Limbs).
Kamal AM, Ara S, Ashrafuzzaman M, Khatun K, Islam MS. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block. Journal of Dhaka Medical College. 2014;23(1):31-6.
Kumar V, Nayak SR, Potu BK, Pulakunta T. Sacral hiatus in relation to low back pain in South Indian population. Bratisl lek listy. 2009 Jan 1;110(7):436-1.
Lanier VS, McKnight HE, Trotter M. Caudal analgesia: an experimental and anatomical study. American journal of Obstetrics and Gynecology. 1944 May 1;47(5):633-41.
Mourgela S, Anagnostopoulou S, Sakellaropoulos A, Koulousakis A, Warnke JP. Sectioning of filum terminale externum using a rigid endoscope through the sacral hiatus. Cadaver study. Journal of neurosurgical sciences. 2008 Sep 1;52(3):71.
Mustafa MS, Mahmoud OM, El Raouf HH, Atef HM. Morphometric study of sacral hiatus in adult human Egyptian sacra: Their significance in caudal epidural anesthesia. Saudi Journal of Anaesthesia. 2012 Oct;6(4):350.
Nadeem G. Importance of knowing the level of sacral hiatus for caudal epidural anesthesia. Journal of Morphological Sciences. 2014 Jan;31(01):009-13.
Nagar SK. A study of sacral hiatus in dry human sacra. J anat Soc india. 2004 Dec;53(2):18-21.
Najman IE, Frederico TN, Segurado AV, Kimachi PP. Caudal epidural anesthesia: an anesthetic technique exclusive for pediatric use? Is it possible to use it in adults? What is the role of the ultrasound in this context?. Revista brasileira de anestesiologia. 2011;61:102-9.
Porzionato A, Macchi V, Parenti A, Caro RD. Surgical anatomy of the sacral hiatus for caudal access to the spinal canal. Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves. 2011:1-3.
Rickenbacher J, Landolt AM, Theiler K. Lanz/Wachsmuth Praktische Anatomie. Rücken: Ein Lehr-und Hilfsbuch der anatomischen Grundlagen ärztlichen Handelns. Springer; 2003 Nov 5.
Sekiguchi M, Yabuki S, Satoh K, Kikuchi S. An anatomic study of the sacral hiatus: a basis for successful caudal epidural block. The Clinical journal of pain. 2004 Jan 1;20(1):51-4.
Senoglu N, Senoglu M, Oksuz H, Gumusalan Y, Yuksel KZ, Zencirci B, Ezberci M, Kızılkanat E. Landmarks of the sacral hiatus for caudal epidural block: an anatomical study. British journal of anaesthesia. 2005 Nov 1;95(5):692-5.
Senoglu N, Senoglu M, Ozkan F, Kesilmez C, Kızıldag B, Celik M. The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults. Surgical and Radiologic Anatomy. 2013 Sep;35(7):579-84.
SHINOHARA H. The size and position of the sacral hiatus in man. Okajimas folia anatomica Japonica. 1999 Aug 20;76(2-3):89-93.
Trotter M. Variations of the Sacral Canal: Their Significance in the Administration of Caudal Analgesia. Anesthesia & Analgesia. 1947 Sep 1;26(5):192-202.
Wang LZ, Hu XX, Zhang YF, Chang XY. A randomized comparison of caudal block by sacral hiatus injection under ultrasound guidance with traditional sacral canal injection in children. Pediatric Anesthesia. 2013 May;23(5):395-400.
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.