Identify surface landmark
enter approx 45 degrees
upon entry anlge needle more parallel
advance needle slightly
then keeping needle stable, advance the cannula. Does not need to be to hilt.
Watch/aspirate for CSF or blood
inject LA (+1-2mcg/kg clonidine) as per Armitage regime, visualising the skin/subcut tissue
The feel of entering cuadal space is similar to the gentle LOR when piercing rubber bung on antibiotic bottle.
If after inserting needle through sacrococcygeal membrane and resistance is encountered on advancing cannula or needle or injection of LA (likely the dorsal aspect of the ventral plate of the sacrum) then withdraw cannula/needle and redirect cranially, walking off the bone if necessary. Better to enter at caudal aspect of sacral hiatus.
More reliable and consistent than nerve blocks.
Use up to approx 20kg weight/7yr