Currently, several types of anesthesia are used in medicine. Most methods of anesthesia for surgical intervention are used locally. One of the most popular methods that is performed epidurally is caudal or sacral anesthesia.
Consider the features of this method, the drugs used, indications, as well as contraindications for pain relief.
What is sacred anesthesia?
Currently, this method is the safest for patients, therefore it is used quite actively. With the help of sacred or, as it is also called, caudal anesthesia, anesthesia occurs in a certain area of the body, so the effect on the body is minimal.
This type of anesthesia can be used regardless of the nature of the surgical intervention, as well as the age of the patient. Despite this, the doctor must observe certain precautions so as not to cause the development of possible complications in the patient.
To carry out the manipulation, an epidural needle of the Tuohi type is used, with the help of which the necessary preparation is injected through the sacrococcygeal ligament into the sacral canal.
There are two types of procedures:
- low - the amount of drug that is administered is insignificant, the anesthetic has a weak effect, as a result of manipulation only the sacral nerves are blocked;
- high - the dose of the drug exceeds twice the low anesthesia, therefore, not only the sacral nerves, but also the radicular nerve centers are blocked.
Indications
Sacral anesthesia requires the permission of either the patient himself or his relatives.
Anesthesia with this method can be carried out in cases:
- operations in the anorectal region;
- surgical intervention in the intimate area or the area below the navel;
- delivery, if you need to expand the birth canal (here you need to act very carefully, since the needle is inserted directly into the area where the baby’s head is already located);
- when prolongation of the effects of epidural analgesia is necessary;
- pain relief after surgery and with severe damage;
- pinching of the vertebral nerves and the resulting strong pain (in this case, anesthesia can slightly reduce pain).
Preparations
Caudal anesthesia is performed with the same drugs as the epidural. Most often these are Ropivacaine, Bupivacaine and Lidocaine.
The instructions for use with Ropivacaine, which refers to local anesthetics, say that the drug is administered slowly, and the dose is calculated depending on the desired effect for the patient. Data on the concentration of the drug, solution volume, dose and duration of anesthesia are also indicated in the instructions.
If we compare this drug with "Lidocaine", which refers to the pain relief of the "last century", it acts more delicately. The dose of the drug is minimal, so it does not cause much harm to the body, while the effect of pain relief is long-lasting.
According to their pharmacological properties, Ropivacaine and Bupivacaine, the instructions for use of which also contain all the detailed information, are quite similar. They are ideal local anesthetics. The only difference is that “Bupivacaine” has a more intense effect on the patient’s body, and the duration of exposure to anesthesia is slightly lower than that of the analogue drug.
Contraindications
Despite the fact that sacred anesthesia is a fairly effective and painless procedure, there are a number of contraindications to it. In addition, the patient himself can refuse this method of anesthesia for individual reasons. It can be replaced with therapy or local anesthesia.
Contraindications to caudal anesthesia:
- there is no gap in the sacrococcygeal region;
- anomalies associated with the structure of the place where the drug should be administered;
- inflammatory process in the place where anesthesia and needle insertion will be performed;
- neoplasms or cysts on the tailbone;
- infection;
- abnormal structure of the spinal cord;
- severe injuries and damage to the tailbone;
- taking anticoagulants that are not compatible with this type of anesthesia.
Possible complications
In the vast majority of cases, the sacred method of analgesia passes without complications and the development of side effects. They can occur only when the technique of anesthesia is impaired.
Possible side effects of sacral anesthesia:
- when piercing vessels, a toxic reaction may occur;
- if the dural sac is damaged due to improper insertion of the needle, pressure rises and respiratory function is disturbed;
- jumps in blood pressure that are not amenable to correction;
- the needle can damage the periosteum or cause pulling pain (pain can bother the patient after the procedure for several months in a row);
- puncture of the rectum with an abnormal or abrupt needle insertion;
- infection and sepsis with non-compliance with the sterility of instruments;
- violation of urination;
- epidural hematoma (rarely develops, most often with coagulants and is removed surgically);
- decreased quality of motor activity.
With the development of side effects or complications, the patient should be under the constant supervision of a specialist until the condition is relieved.
Sacral Anesthesia Technique
In order for the manipulation to not cause complications, it must be carried out slowly and carefully. Initially, the specialist carefully inspects the place where the needle will be inserted. It is on the accuracy of this process that the entire effect of anesthesia depends.
In general, the technique of caudal anesthesia is as follows:
- The patient is preparing for this anesthesia, as for normal anesthesia. This applies to refusing food at least ten hours before the manipulation.
- Drugs are administered when the patient is lying on his side in an embryo position. The needle can also be inserted while lying on the stomach with legs slightly spread to the side. " This is necessary so that the gluteal muscles are as relaxed as possible.
- The doctor palpates the tailbone, moving his fingers up the spine. The sacral channel where the drug will be administered is located in the subcutaneous void.
- A catheter needle for epidural anesthesia is treated with antiseptics. Serious consequences can occur when an infection is introduced into the sacral canal.
- So that the drug does not leak during a puncture, the place is covered with cotton swabs.
- First, a test dose of anesthetic is introduced and the patient is monitored. If a swelling appears on the spot, then this method of anesthesia is not suitable. In the absence of reaction, there is a gradual and slow increase in the amount of the drug to the required dosage.
- Upon completion of drug administration, the puncture site is sealed.
On average, analgesia occurs 20 minutes after drug administration. In this case, the patient should not feel severe pain. Next is just control over the patient's condition during surgery. Important indicators are blood pressure and heart rate.
Conclusion
Sacral anesthesia is most often used for delivery at the second stage of labor. This is an effective and painless method, which, subject to the technique and rules of the procedure, does not cause side effects. In addition, anesthesia can be performed as a normal anesthesia procedure, for example, with strong compression of the nerves in the lower part of the spine.