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BJA Advance Access originally published online on September 9, 2005
British Journal of Anaesthesia 2005 95(5):692-695; doi:10.1093/bja/aei236
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oxfordjournals.org

Landmarks of the sacral hiatus for caudal epidural block: an anatomical study

N. Senoglu1,*, M. Senoglu2, H. Oksuz1, Y. Gumusalan3, K. Z. Yuksel2, B. Zencirci1, M. Ezberci1 and E. Kizilkanat4

Departments of 1 Anesthesiology, 2 Neurosurgery and 3 Anatomy, KSU Medical School, 46050 Kahramanmaras, Turkey. 4 Anatomy CU Medical School, 01330 Balcali, Adana-Turkey

* Corresponding author: Kahramanmaras Sutcuimam Universitesi, Tip Fakültesi Anesteziyoloji Anabilim Dali, 46050 Kahramanmaras, Turkey. E-mail: nimetsenoglu{at}hotmail.com

Background. This study determined the landmarks for caudal epidural block (CEB) after morphometric measurements of the sacral hiatus on dry sacral bones. Anatomical features of the sacral hiatus of clinical importance during CEB, along with distances and angles of use in detecting the apex, were measured. This provides detailed knowledge of the anatomy of the sacral hiatus and practical landmarks.

Methods. Ninety-six dry sacral bones were used. Anatomical measurements were made with a Vernier caliper accurate to 0.1 mm.

Results. Two sacral bones were excluded since they had total posterior closure defect. Agenesis of the sacral hiatus was detected in six sacral bones. As the posterior superior iliac spines impose on the superolateral sacral crests of the sacrum, the latter were accepted as forming the base of a triangle. The distance between the two superolateral sacral crests and the distances between the sacral apex and the right and left superolateral sacral crest were 66.5 (SD 53.5), 67.1 (10.0) and 67.5 (9.5) mm respectively, on average.

Conclusion. The triangle formed between the apex of the sacral hiatus and the superolateral sacral crests was found to have the features of an equilateral triangle. The sacrum and sacral hiatus are variable anatomical structures. However, the equilateral triangle located between the apex of the sacral hiatus and superolateral sacral crests will certainly be of use in determining the location of the sacral hiatus during CEB.


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