Pudendal block

Mathieu D’Hondt
Mohammed Abu Hilal

Injection fluid: Marcaine 0.25% with adrenaline (total 20mls – can use this concentration / quantity without adrenaline)

The caudal block starts with a digital rectal exam  to localize the bony pelvis. A right-handed surgeon should use the left index finger to localize the left ischial tuberosity. A left-handed surgeon should use the right index finger.  This inserted index finger pushes the rectum slightly towards the side for injection.

With the other, dominant hand, insert the needle tip through the peri-rectal skin, 2 to 3 cm from the anus, at 3 o’clock, aiming for the index finger in the rectum.  When you feel the slightest pressure coming  close to your finger, aspirate to ensure you are not in the pudendal artery, then inject 10 mL of local anesthetic with some fine movement of the needle tip while injecting to ensure even distribution of the fluid.