Sacral Anesthesia an Experimental and Clinical Study

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Abstract
An epidural injection of 20 cc. of novocaine sol. is sufficient to anesthetize the 5th sacral nerve completely and the 4th (sometimes the 3rd) less completely. A 30 cc. injection anesthetizes them completely. A 40 cc. injection anesthetizes the 5th, 4th, and 3rd nerves completely and the 2nd and 1st less completely. In order to anesthetize completely the 1st 2 sacral nerves, it is necessary to use volumes greater than 40 cc. (50 to 75 cc.) or to combine a smaller caudal injection (30 to 40 cc.) with transacral injection of the upper 2 sacral foramina. Since volumes greater than 40 cc. are apt to reach high levels about the cervical cord and medulla, the combined method is preferable where it is necessary to anesthetize the first 2 sacral nerves. In our experience, weaker solutions of novocaine (1% or even less) are almost if not as effective as the stronger solutions (2% or more) and are to be preferred. The presence of excessive perineural fat and connective tissue makes it difficult for aqueous solutions of dye or novocaine to reach the bare nerves and suggests the use of some more penetrating anesthetic solution.

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