. Regional anesthesia : its technic and clinical application . must not be used as a routineprocedure. It has, besides, the disadvantage of requiring the lithotomyposition, which is incompatible with the paravertebral lumbar blockoften associated with the blocking of the sacral nerves for operationson the pelvic organs. CAUDAL BLOCK Caudal block is also known as extradural or epidural block. Itconsists in passing the needle through the sacra hiatus and depositingthe anesthetic fluid within the sacral canal. It differs from intraspinalblock (spinal anesthesia) in that the solution is distribute
. Regional anesthesia : its technic and clinical application . must not be used as a routineprocedure. It has, besides, the disadvantage of requiring the lithotomyposition, which is incompatible with the paravertebral lumbar blockoften associated with the blocking of the sacral nerves for operationson the pelvic organs. CAUDAL BLOCK Caudal block is also known as extradural or epidural block. Itconsists in passing the needle through the sacra hiatus and depositingthe anesthetic fluid within the sacral canal. It differs from intraspinalblock (spinal anesthesia) in that the solution is distributed outside thedura mater. BLOCKING OF SPINAL NER\rES 273 The sacral hiatus, through which the needle must be introducedbefore it is advanced deeply into the sacral canal, is the lower extremityof the spinal canal. It is an opening resulting from the defective ornon-closure of the laminas of the last sacral vertebra, screened bya thin layer of fibrous tissue called the sacrococcygeal membrane(postero-inferior obturator membrane of Cathelin), stretched between. Fig. 206.—Posterior aspect of the sacrum. the sacrum and the coccyx, and bounded on each side by the sacro-coccygeal ligaments. The sacral hiatus lies at about the juncture ofthe sacnun with the coccyx, and is bounded b} the sacral cornua oneach side and the spinous process of the fourth sacral vertebra on themidline a little higher up. It has the shape of an inverted V or arms of the inverted V or U are generally salient edges and their18 274 REGIONAL ANESTHESIA extremities prominent tubercles; but in a certain number of cases theseanatomic features are thin and fiat and cannot be defined by palpation,even in lean patients. The sacral canal is a prismatic space occupying the whole height ofthe sacrum. Its upper extremity is connected with the spinal canal,of which it is the continuation. Its lower extremity is the sacral hiatus.
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