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Unanticipated Dural Tap in Caudal Anesthesia: A Case of Intrasacral Meningocele

Inagawa, Gaku MD; Miwa, Takaaki MD; Hiroki, Koichi MD

doi: 10.1213/01.ANE.0000158997.26746.DE
Letters to the Editor: Letters & Announcements

Department of Anesthesia; Kanagawa Children’s Medical Center; Yokohama, Japan; inagawa@med.yokohama-cu.ac.jp

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To the Editor:

Dural puncture, although rare, is one of the complications of caudal anesthesia. Unrecognized dural puncture and subsequent injection of a large volume of anesthetic solution leads to respiratory arrest and total spinal anesthesia (1,2). We report an unanticipated dural tap while performing caudal anesthesia. Postoperative magnetic resonance imaging examination revealed the presence of intrasacral meningocele in the sacral canal.

An otherwise healthy 2-yr-old boy had an undescended testis and was scheduled for orchidopexy. Preoperative physical examinations showed no other abnormal pathology. The caudal anesthesia was performed under general anesthesia. An IV disposable needle was inserted via the sacral hiatus and was advanced until it was judged to penetrate the sacrococcygeal membrane. Immediately, clear fluid dripped from the proximal end of the needle. Caudal anesthesia was abandoned because of potential dural puncture. Postoperative magnetic resonance imaging showed an intrasacral meningocele in the sacral canal (Fig. 1).

Figure 1

Figure 1

Caudal anesthesia is believed to be a reliable technique that is easy to perform, even by beginners (3). Although rare, consideration should always be given to the existence of an anatomical anomaly in pediatric patients. Therefore, the importance of gentle and careful aspiration before local anesthetic injections cannot be overemphasized. We strongly suggest that great care must be taken not only to detect intravascular injection but also to detect subarachnoidal injection.

Gaku Inagawa, MD

Takaaki Miwa, MD

Koichi Hiroki, MD

Department of Anesthesia

Kanagawa Children’s Medical Center

Yokohama, Japan

inagawa@med.yokohama-cu.ac.jp

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References

1. Afshan G, Khan FA. Total spinal anaesthesia following caudal block with bupivacaine and buprenorphine. Paediatr Anaesth 1996;6:239–42.
2. Desparmet JF. Total spinal anesthesia after caudal anesthesia in an infant. Anesth Analg 1990;70:665–7.
3. Veyckemans F, Van Obbergh LJ, Gouverneur JM. Lessons from 1100 pediatric caudal blocks in a teaching hospital. Reg Anesth 1992;17:119–25.
© 2005 International Anesthesia Research Society