The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.
Steroid injection has been around since the early 1950s, and it remains a primary treatment for general practitioners all the way to orthopedic surgeons. Why? First of all, it offers the hope of quick relief. Second, it’s a Big Fat Cash Cow. Let’s do the math. Say you have sciatica, and you go to see Dr. Prick Butt and he says, “Not much I can do for you other than give you a steroid injection. Of course, it may take up to three of these to achieve the best results.” Three injections @ $150 per injection = $450. Now, taking into account that the average orthopedist probably sees at least 20 patients a day and works 180 days a year, that comes to 3,600 patients. If 20 percent of those patients get three steroid injections, that’s an annual income of $324,000 ($450 X 750 patients). That’s for 10 minutes of work per patient. And you wonder why things haven’t changed in more than 50 years.