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Anesth Analg 2002;95:1067-1070
© 2002 International Anesthesia Research Society

REGIONAL ANESTHESIA

The Median Approach to Transsacral Epidural Block

Tomoki Nishiyama, MD PhD*, Kazuo Hanaoka, MD PhD{dagger}, and Youji Ochiai, MD PhD{ddagger}

*Surgical Center, The Institute of Medical Science, {dagger}Department of Anesthesiology, The University of Tokyo; and {ddagger}Department of Anesthesiology, Matsuda Hospital, Kurashiki, Japan

Address correspondence and reprint requests to Tomoki Nishiyama, MD, PhD, Surgical Center, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, 108-8639, Tokyo, Japan. Address e-mail to nishiyam{at}ims.u- tokyo.ac.jp.

Transsacral epidural block may be useful for surgery or cancer pain affecting the rectal, anal, or urethral region. The procedure through the dorsal sacral foramen is difficult because of the long insertion route. We investigated whether the transsacral epidural block could be simplified by using a median approach instead of a lateral approach through the foramen. Thirty patients for transurethral resection of bladder tumor had a catheter placed 5 cm cephalad at S2-3 (15 patients) or caudal (15 patients) epidural space using a 19-gauge Tuohy needle by the median approach. Lidocaine 2% 15 mL was administered for anesthesia. Anesthesia level (sensory block to cold), hemodynamics, and side effects were compared between the two approaches. The success rate of anesthesia was 87% for transurethral resection of bladder tumor (proximal anesthesia level higher than T10) and 100% for the sacral region (S1-5) in both groups. The highest level of anesthesia (median, T8 in the S2-3 group and T9 in the caudal group) was obtained in 20 min in both groups. No side effects were observed. We conclude that the median transsacral epidural approach is technically feasible in adults and presents an alternative to caudal block.

IMPLICATIONS: The median approach to transsacral epidural block has been described in children. We found that it is technically feasible in adults and presents an alternative to caudal block for procedures on the rectal, anal, or urethral region.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2002 by the International Anesthesia Research Society.