A caudal epidural, sometimes called caudal epidural anesthesia, refers to the administration of pain medication into the portion of the spinal canal known as the caudal canal. The caudal canal is an extension of the epidural space, which is a narrow opening towards the outer portion of the spinal canal. Generally, the pain medication delivered by a caudal epidural is a local anesthetic, although in some cases, steroids are used. Administering a local anesthetic or a steroid to this region prevents the nerves that reside in the caudal canal from transferring a pain message to the brain, which prevents patients from feeling any unpleasant sensations. Typically, a caudal epidural is used to numb patients below the naval.
Caudal epidural injections of local anesthetic pain medication are used to prevent pain during and after surgical procedures in the lower area of the body such as the legs, groin and pelvic regions. It is safe for use in all people including children and the elderly. Caudal epidurals are also often used to deliver steroid injections. Steroid injections into the caudal canal have generally been recognized as an effective method of relieving the lower leg pain that is associated with conditions such as lumbar spinal stenosis, which occurs when the spinal canal contracts and results in the constriction of the spinal nerves.
The caudal epidural originated in Paris in 1901 when Jean-Anthanase Sicard and Fernand Cathelin—working independently of each other—discovered spinal anesthesia. Cathelin went on to find that anesthesia administered into the caudal canal was very safe and also very effective at relieving pain in the lower extremities. Later, the caudal epidural became a popular method to treat pain experienced by women during natural childbirth and childbirth requiring the surgical practice known as the Caesarean section. Using an epidural during childbirth dates to 1909 when a German obstetrician named Walter Stoeckel introduced the procedure into his practice.
Pain medication can be delivered in the form of a one-time injection or it can be delivered continuously. Continuous caudal injections deliver pain medication to the caudal canal in measured, repeated doses. This type of caudal epidural is often used when pain relief is needed for an extended period of time, such as during a surgical procedure or childbirth. Robert Hingson, James Southworth and Waldo Edwards—who all worked at a United States Marine hospital—are credited as having developed the technique required to deliver continuous pain medication to the caudal canal in 1942.