open access

Vol 82, No 3 (2023)
Original article
Submitted: 2022-04-16
Accepted: 2022-08-16
Published online: 2022-08-25
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Morphological and morphometric features of sacral hiatus and its clinical significance in caudal epidural anaesthesia

E. Nastoulis1, D. Tsiptsios1, P. Chloropoulou2, V. Karapepera1, V. Thomaidis1, P. Pavlidis3, A. Fiska1
·
Pubmed: 36165903
·
Folia Morphol 2023;82(3):603-614.
Affiliations
  1. Department of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
  2. Department of Anaesthesiology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
  3. Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

open access

Vol 82, No 3 (2023)
ORIGINAL ARTICLES
Submitted: 2022-04-16
Accepted: 2022-08-16
Published online: 2022-08-25

Abstract

Background: Caudal epidural block (CEB) failure or complications are not unheard
even among experienced anaesthesiologists and are usually due to sacral hiatus
(SH) anatomy variations. The aim of the present study is to observe, record and
analyse important anatomical features of SH and correlate them with potential
CEB limitations.
Materials and methods: The SH of 155 complete and undamaged Greek adult
dry sacra of known sex were included in the study. Three non-metric (shape of
SH and location of hiatal apex and base in relation to level of sacral/coccygeal
vertebra) and five metric parameters (height of the SH, transverse width of the
SH at the base, anteroposterior diameter of the SH at the level of its apex and
the distance from the sacral apex and base to the upper border of S2 foramina)
were evaluated.
Results: Inverted U (34.83%) and inverted V (26.45%) were the commonest
shapes. Hiatal apex and base were most commonly related to the level of S4
(78.70%) and S5 vertebra (89.03%), respectively. Mean height, depth and intercornual
distance were 19.05 ± 8.65 mm, 5.39 ± 1.84 mm and 12.41 ± 3.16 mm,
respectively, whereas mean distance between the upper border of S2 foramen
and the apex and base of the SH were 46.34 mm and 63.48 mm, respectively.
Anatomical variations of SH that might be responsible for CEB failure, such as
elongated SH, absence of SH, complete dorsal wall agenesis of sacral canal and
narrowing (< 3 mm) at the apex of SH were found in 17.43% of sacra (male
10.94% and female 25.22%).
Conclusions: This study suggests a potential risk of failure of CEB in Greek patients,
especially in females, which should be kept in mind while giving caudal
epidural anaesthesia.

Abstract

Background: Caudal epidural block (CEB) failure or complications are not unheard
even among experienced anaesthesiologists and are usually due to sacral hiatus
(SH) anatomy variations. The aim of the present study is to observe, record and
analyse important anatomical features of SH and correlate them with potential
CEB limitations.
Materials and methods: The SH of 155 complete and undamaged Greek adult
dry sacra of known sex were included in the study. Three non-metric (shape of
SH and location of hiatal apex and base in relation to level of sacral/coccygeal
vertebra) and five metric parameters (height of the SH, transverse width of the
SH at the base, anteroposterior diameter of the SH at the level of its apex and
the distance from the sacral apex and base to the upper border of S2 foramina)
were evaluated.
Results: Inverted U (34.83%) and inverted V (26.45%) were the commonest
shapes. Hiatal apex and base were most commonly related to the level of S4
(78.70%) and S5 vertebra (89.03%), respectively. Mean height, depth and intercornual
distance were 19.05 ± 8.65 mm, 5.39 ± 1.84 mm and 12.41 ± 3.16 mm,
respectively, whereas mean distance between the upper border of S2 foramen
and the apex and base of the SH were 46.34 mm and 63.48 mm, respectively.
Anatomical variations of SH that might be responsible for CEB failure, such as
elongated SH, absence of SH, complete dorsal wall agenesis of sacral canal and
narrowing (< 3 mm) at the apex of SH were found in 17.43% of sacra (male
10.94% and female 25.22%).
Conclusions: This study suggests a potential risk of failure of CEB in Greek patients,
especially in females, which should be kept in mind while giving caudal
epidural anaesthesia.

Get Citation

Keywords

sacrum, sacral hiatus, anatomical variations, caudal epidural anaesthesia, Greece

About this article
Title

Morphological and morphometric features of sacral hiatus and its clinical significance in caudal epidural anaesthesia

Journal

Folia Morphologica

Issue

Vol 82, No 3 (2023)

Article type

Original article

Pages

603-614

Published online

2022-08-25

Page views

1073

Article views/downloads

717

DOI

10.5603/FM.a2022.0078

Pubmed

36165903

Bibliographic record

Folia Morphol 2023;82(3):603-614.

Keywords

sacrum
sacral hiatus
anatomical variations
caudal epidural anaesthesia
Greece

Authors

E. Nastoulis
D. Tsiptsios
P. Chloropoulou
V. Karapepera
V. Thomaidis
P. Pavlidis
A. Fiska

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