Clinical Experience with Caudal Epidural Block in Adult Anorectal Surgery: A Case Series

Ricardo Serna-Muñoz; Roberto Jimenez-Contreras; Jose Eduardo Etulain-Gonzalez; Isabella Joceline Albuerne Estrada

Authors

Ricardo Serna-Muñoz Anesthesiology Resident, The American British Cowdray Medical Center, Mexico City
Roberto Jimenez-Contreras Anesthesiology Physician, The American British Cowdray Medical Center, Mexico City
Jose Eduardo Etulain-Gonzalez Anesthesiology and Critical Care physician, The American British Cowdray Medical Center, Mexico City
Isabella Joceline Albuerne Estrada Anesthesiology and Critical Care physician, The American British Cowdray Medical Center, Mexico City

Keywords:

Caudal epidural block, Anorectal surgery, Postoperative analgesia, Hemorrhoidectomy, Regional anesthesia

Abstract

This prospective, observational case series evaluated the postoperative analgesic efficacy and safety of caudal epidural blocks in 36 adult patients undergoing elective hemorrhoidectomy under general anesthesia at Centro Médico ABC from March 2024 to February 2025. Postoperative pain scores remained consistently low, with median Visual Analog Scale (VAS) scores of 0 in the Post-Anesthesia Care Unit (PACU), 1 at 6 hours, 2 at 12 hours, and 2 at 24 hours. No patient required rescue analgesia in the PACU, and fewer than 15% required opioid or NSAID rescue medication at any point within the first 24 hours. The anesthetic mixture typically included ropivacaine (mean 37.5 mL) and lidocaine (mean 100 mL), with clonidine administered in 55.6% of cases. Intraoperative hypotension (MAP < 65 mmHg) occurred in 55.6% of patients and was managed with ephedrine in 50% of cases. Importantly, no block-related complications, such as urinary retention or systemic toxicity, were reported. These findings suggest that caudal epidural block is a viable, safe, and effective regional anesthetic technique for providing sustained postoperative analgesia in adult anorectal surgery, potentially reducing opioid exposure and facilitating ambulatory recovery.

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