"Once reached, 5-6 mL of contrast in injected, confirming extradural and extravascular location, and acting as a visual marker for the ascent of steroid / local anaesthetic. The therapeutic mixture is then injected (typically 3-5 mL:1-2 mL of betamethasone and 2-3 mL of bupivacaine). The previously injected contrast should be seen to disperse, ideally no higher than L5/S1 1-2."
"Some authors advocate the use of larger volumes of dilute injectate to effectuate larger area of effect 4-5."
"The sacral hiatus is palpated (bordered by the sacral cornua), and the needle advanced at approximately 45 degrees in the midline. Screening should be performed initially in AP projection to ensure midline placement (this is usually not a problem) and then in lateral projection, visualising the needle ascending the sacral canal. Lateral screening can be used to both plan skin entry and degree of needle angulation as not everyone's sacral hiatus is at 45 degrees."
Expected headings
"Positioning/room set up"
"Any infection of the skin of the natal cleft is also a contraindication (e.g. intergluteal pilonidal sinus)."
"As with other epidural injections, recovery in the department for 20-30 minutes minimum is recommended, as a proportion of patients will experience transient numbness, weakness or loss or proprioception, making ambulation difficult and dangerous."