Does CSF come to syringe during caudal blockade?

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Background and Aims Caudal anesthesia is a frequently used anesthetic method for lower abdominal and urogenital surgery. It provides sensory and partially motor block at T10-S5 dermatomal level. In this case report, we aimed to present the anesthetic management of a pediatric patient that clear liquid came into the caudal needle during caudal anesthesia.

Methods A boy (10-year-old-32 kg), who had planned testiculer surgery under caudal block+general anesthesia, patient have undescended testis and had no additional systemic health problem. Following anesthesia induction, LMA was inserted. Anesthesia was maintained with sevoflurane inhalation. Patient positioned lateral decubitus, surgical asepsis was applied, 22 G-3.0 cm needle was inserted through the sacral hiatus. When the needle was at the 1st. cm, the sacrococcygeal ligament was passed but clear liquid was obtained at aspiration. Liquid sample was taken and the sample was sent to evaluation. Postoperative CT scan was performed to evaluate the caudal anatomy. The sample was confirmed to be CSF. Computed tomography imaging revealed ‘Hypodense, consistent with a Tarlov cyst, there is an area of CSF density and the dural sac extends to the S4 level’.

Results The most serious complications during caudal block are total spinal anesthesia due to intrathecal injection and systemic local anesthetic toxicity due to intravascular injection. Although the use of ultrasonography has reduced these complications, it has not completely eliminated them.

Conclusions It should be kept in mind that anatomical variations may occur during caudal block.Needle aspiration shouldn’t be neglected during caudal anesthesia even underwent ultrasonography guidance.