Canadian Journal of Anesthesia, Vol 11, 609-613, Copyright © 1964 by Canadian Anesthesiologists' Society

Syndromes douloureux et anesthésie caudale thérapeutique

¹ Hôpital du Saint-Sacrement, Québec, Qué

The sedentary habits of our population are one cause of the increase in the frequency of occurrence of lumbar pains The lumbosacral region is often required to make a considerable effort for which it is not prepared

Sixty to seventy per cent of adults suffer, have suffered, or will suffer from chronic lumbar pain or acute lumbar pain with or without root neuralgia

The anaesthetist should be able to render a service in the treatment of simple lumbar pains, but he is most often consulted for the treatment of patients suffering from acute lumbar pain accompamed by root neuralgia, usually due to a hermated intervertebral disk

Anatomically, it should be recalled that the normal disk is composed of two parts the nucleus pulposus and the annulus fibrosis The nucleus pulposus has the consistency of a homogeneous jelly In the lumbar region it is situated in the lower and posterior part of the disk The lamellar ring or annulus fibrosis is composed of a series of fibrous lamelli disposed around the nucleus

During movements of the spine this nucleus is easily displaced and deformed During flexion the nucleus is displaced posterioly and takes an ovoid form with the large end posteriorly In extension the opposite occurs, the nucleus being displaced forward

In the event of trauma, a sudden movement or an effort to lift a weight, the nucleus pulposus is able to infiltrate through a gap in the lamellar ring which is more or less altered Nerve root compression and intense pain may result The roots of L5 and S1 are most often involved, with pain in the distribution of the sciatic nerve

The treatment of patients with lumbar pain and acute radiculitis necessitating hospitalization is usually as follows at the l'Hôpital du Saint-Sacrement 1 Bed rest with a board under the mattress 2 Anti-inflammatory treatment (Tandearil, Phenylbutazone) 3 Daily vertebral traction with enough force to relieve the muscullar spasms 4 Vertebral manipulations 5 Ultrsonic therapy and stimulation 6 Sedatives and narcotics for patients with severe pain 7 Caudal anaesthesia with 50 cc of 05 per cent lidocame

We leave the patient in the prone position for two hours after injection and repeat the caudal anaesthesia on two or three days if necessary

Caudal anaesthesia seems useful to us for the following reasons 1 To relieve the pain and muscular spasms which accompany it 2 A volume of 45 cc injected with pressure, after a a preliminary dose of 5 cc has been infected to ensure that one is properly in the epidural space, may break down certain adhesions and free the nerve roots; 3 The ventral or prone position tends to extend the spine The muscular relaxation associated with this extension favours the displacement of the nucleus polposus anteriorly and the reduction of the hermation of the disk

This conservative treatment appears useful to us m the case of those patients having an acute lumbar pain with recent radiculitis In the case of patients, who have suffered for many years, they have been reheved sufficiently or are subjected in the first instance to a discectomy

Note:

Ce travail a été presenté à la réunion de la Societé Canadienne des Anesthésistes, division du Québec, tenue à Québec le 9 mars 1963