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.

The caudal block 1
The caudal block 2

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.

The caudal block 3

Repeat the procedure on the other side. First localize the bone, aim 2-3 cm. out from the anus at 9 o’clock, aiming slightly medially until you feel the slightest pressure of the needle close to your index finger.
Aspirate to check for the pudendal artery, then inject an additional 10 mL on
this side.

Holdafbeeding video

Performance of a pudendal block (Steve Arnold)