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Question of the Day
You are placing a caudal block for a neonate for bilateral inguinal hernia repair. The dural sac in this patient MOST likely extends to which spinal level?
Explanation
The dural sac in the neonate can extend to sacral (S) 3-4. This is lower than the adult, which extends to S2. The lower positioning of the dural sac in the neonate may make a dural puncture more likely during caudal block placement. By one year of age the dural sac has migrated to the adult level of S2. Providing 1 cc/kg of local anesthetic in the caudal route in a neonate or infant will provide a sensory block from S5 to T10. The entry of the caudal block is S5 and the local anesthetic will bathe the nerve roots starting from the bottom of the spinal. The height of the block depends on the age of the patient and the volume of local anesthetic. Patients less than 10 kg will often have easy spread up the neuraxial space. In general, 1 cc/kg of local anesthetic will provide a low thoracic block (T10 block). 1.25 cc/kg will provide a mid thoracic block (T6 block).