The incidence of tissue coring during the performance of caudal injection in children

Abstract Background and Objectives . The performance of caudal injection (CI) has become a routine part of pediatric anesthesia. The intraoperative and immediate postoperative complications of CIs have been reported extensively. Although the long-term consequences of CI are unknown, they may include the development of epidermoid tumors in the spinal canal. Such tumors have been attributed to tissue coring (the process by which pieces of tissue are removed by a needle as it passes through the tissue) and the subdural deposition of such tissue. Methods . In this study, we examine the internal needle of 20-gauge i.v. cannulae from 50 CIs for evidence of tissue coring. Results . We found a total coring incidence of 54% (95% confidence interval = 40–68%). Epidermal tissue was present in 33% of the positive samples. Fat was present in 67% of the positive samples and bloody material in 26%. This study provides an estimate (with a 95% confidence interval) of the rate of coring during CI performed with hollow point needles. Conclusions . These findings suggest that technical modifications may improve patient safety. The results also have implications for long-term follow-up of caudal anesthetics. Techniques for reducing the incidence of tissue coring during the performance of CI are discussed.