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clinmed/2000070007v1 (August 15, 2000)
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Caudal epidural analgesia in palliative care: a review of case notes.
Ian N Back, and Ilora G Finlay
During three years, 41 patients were treated with caudal epidural injections in a palliative care setting. Thirty nine patients received 65 caudals containing corticosteroid for malignant pain, and their case-notes are reviewed. Response to the injection, as judged from the case-notes was 'good' in 36 cases (56%), 'some' in 16 (25%), and 'none' in 12 (19%); response was not recorded in one patient. The response in patients with pain limited to areas supplied by sacral nerves showed a higher percentage of 'good' responses, 68% versus 41% (p < 0.05) than for those with pain also in areas supplied by lumbar nerves. Two patients had caudal injections of local anaesthetic alone to provide anaesthesia for manual evacuation of impacted faeces, with excellent results. The caudal approach to the epidural space is discussed. It is suggested that caudal corticosteroid injections are a useful treatment for mixed malignant pelvic pain, and that caudal anaesthesia can provide excellent conditions for manual evacuation of impacted faeces.