Ultrasound-Guided Caudal Epidural Block

Intractable lower back pain is increasingly adding to the morbidity of the general population. Conservative therapy failure and refusal for operative procedures has led to the use of regional pain relief options in the form of caudal epidural blocks. Caudal epidural steroid injections, once popular among anaesthetists for lower abdominal surgeries in paediatric patients, have transitioned from the operating theatres to the outpatient departments (OPD) and become an important part of orthopaedic practice for pain relief. Previously, these procedures were performed blindly, which was accepted by both the medical community and patients, despite a failure rate of 5%-25% and varying degrees of success. However, with the advent of musculoskeletal (MSK) dedicated ultrasound (US) machines, the accuracy and success rates of these procedures have significantly improved primarily because of reduction in complication rates, more accurate needle placement in the sacral hiatus, and consequently, a lower percentage of failed blocks.