Anatomical hierarchy of puncture approach for sacral canal block anesthesia

During sacral anesthesia, the patient can be in a prone position. The prone position for men and non-pregnant women can make the body surface signs more obvious and easier to complete the nerve block. For pregnant women, it is suitable for side lying position, knee-chest lying position can also be considered.

Thinner patients are more likely to see the sacral angle about 5 cm from the tip of the tail. After determining the position, the surgeon places the palms of the index finger and middle finger on the two sacral angles, and infiltrates the two points with local anesthetic injection. Then pierce between the two sacrums at an angle of 45°, and pierce the forward needle into the superficial ligament of the dorsal sacrococcygeal ligament, and enter the sacral canal when the resistance disappears.

When the puncture needle touches the sacrum, the angle of the needle should be changed. In men, it is almost parallel to the skin, that is, the needle is inserted at an angle of 5° or less with the skin; in women, the angle is slightly larger, and the needle can be inserted at an angle of 15° . At this time, the puncture needle has entered the sacrum to a depth of about 2 cm. Usually, the distance is appropriate to avoid the danger of puncturing the dura mater. Puncture to this position, there should be no blood after sucking back, otherwise the position of the puncture needle needs to be adjusted until there is no blood. Whether to suck out the cerebrospinal fluid is very important to check whether the dura mater is punctured, because the dura mater may extend downward beyond the level of the sacrum 2, especially in children. In this case, it is possible to pierce the dura mater.

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