Caudal epidural for pain management

Caudal epidural block with local anaesthetic and depo-steroid medication maybe recommended for the treatment of conditions causing pain in the tailbone, pelvis and lower back.

The procedure involves the use of a combination of a local anaesthetic and depo-steroid medication into the epidural space around the roots of the spinal nerves.  Caudal epidural is performed through the sacro-coccygel membrane between the sacral and the tail bone at the bottom of the spine.

The patient will usually be referred to the pain consultant by an orthopaedic surgeon, GP, or another hospital specialist or the patient can self-refer. Before this treatment is recommended, the patient will be thoroughly examined, medications will be optimised and all investigation results are taken into consideration during the initial or follow-up consultation.

Patient considerations

Careful assessment of the safety of performing this procedure will be done as the patient’s general health, allergies, the use of blood-thinning medication, other medications and conditions such as anxiety, depression, needle phobia will be taken into consideration. 

Procedure description

The procedure is performed in a theatre suite under aseptic conditions. It is been given at the bottom of the spine while the patient is lying on his front been fully awake and thus able to report any discomfort during the procedure. It is done under the guidance of X-ray or ultrasound for best accuracy and safety. Leg weakness or numbness, numbness in the perineum with some hesitancy in voiding urine, are common immediate side effects that are short-lived. 

All other side effects and complications are fully explained in the patient information leaflet.  The patient is been looked after and closely monitored for at least one hour. Checks of blood pressure, heart rate are been done every 5-10 minutes. The patient’s legs muscle power and sensation will be tested, the patient will enjoy a drink and a snack before been allowed to go home. 

The patient should not drive or use public transport following the procedure. A responsible adult should be with the patient for the first 24 hours following the treatment.

Follow-up after procedure

The patient will be followed up for re-examination, advice on continuing/discontinuing painkilling medication and further rehabilitation four weeks after the procedure.