Best technique/equipment for caudals

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15+ Year Member
May 27, 2006
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In a recent post by Algosdoc, he mentioned his technique for caudals using a blunt needle. I am just starting out as an interventionalist, having done primarily TFESIs in fellowship. What techniques/equipment do folks recommend? Catheters yes/no? Which brand? arrow vs. epimed vs. other? Sharp vs. blunt needles? Any cool tricks to know? Besides prep the heck out the field? Curve or no-curve? Thanks team!

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15+ Year Member
May 30, 2005
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And what fellowship trained you without getting you sufficient numbers???

Use a 17G Tuohy with or without Portex catheter (20g)

Can you identify landmarks? Start lateral in Fluoro. Look at Fenton or similar first. I recommend a 27g 1 1/4 to raise a wheal, 25G 3.5 " spinal needle with bent tip (short arm) for deeper tissues and to anesthetize the ligament.

Pop in the 17G Tuohy using AP and lateral imaging. Inject contrast as soon as you cross through the ligament (use the fluoro to identify cephalad penetration in lateral view). Check AP view andmake sure contrast flows where you want the meds to go. Use cath as optional to approach the selected roots or just push in the meds.


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May 3, 2005
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Depends on the target. If the target is L5S1 disc then a simple 25ga 3.5 inch curved tip needle is an excellent method of medication administration....the needle is advanced in the midline starting inferior to the SC ligament (usually easily identified on lateral fluoroscopy). The needle is advanced at a 30 deg angle to the tangenial line at the level of the SC ligament and once the ligament is entered, the needle is advanced. With a curved tip, often the posterior cortex will be encountered prior to final advanced position, therefore the needle tip must be alternately rotated anterior and posterior during advancement. Typically the final position is at the level of S3. 10cc of solution will reach L5 without difficulty, however sometimes larger volumes are required to reach L4-5, and definitely larger volumes are needed to reach L3-4, thereby diluting the effectiveness of the steroid. So for L4-5 and above pathology, I typically use a styletted catheter system such as an epimed or arrow system or you can simply use a styletted catheter such as the portex in an epidural tray.
Of course my preferred technique uses a blunt needle advanced anterior epidural space midline to whatever level is needed but I would not recommend this as a generally used technique since there is a learning curve that is steep...