Morphometric study of sacral hiatus in adult Indian human dry sacra and its significance in caudal anesthesia
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Keywords
Scaral hiatus, sacral vertebra, apex of sacral hiatus, Scaral foramina
Abstract
Introduction: Caudal epidural block (CEB) not achieving the desired outcome or causing complications can occur, even when administered by experienced anesthesiologists. These occurrences are typically attributed to Sacral hiatus (SH) anatomy variances.
Objective: The present study aimed to observe, document and analyze significant anatomical characteristics of SH and establish connections between these features and potential restrictions in the effectiveness of CEB.
Materials and methods: The observational study included the SH of 53 adult dry Indian sacra. The characteristics examined in the study included shape, width, and linear distances. The collected measurements were organized and categorized based on sacral indices. Statistical Package for the Social Sciences (SPSS) software, version 25.0, was employed for the analysis. The mean and standard deviation (SD) were calculated for each measurement. A comparison of the measurement values was conducted using Student's t-test.
Results: The most common types of Sacral hiatus were the inverted V (N= 21), inverted U (N= 29) and dumbbell-shaped (N= 3). In all groups of dry Sacra, the most frequently observed position of the Apex of the SH was at the Sacral 4th vertebral level, while the base of the SH was commonly found at the Sacral 5th vertebral level. Width of SH was 11.8±2.1, 12.5±2.4 mm and 11.6±3.5mm, respectively, with a P-value of 0.1. The mean SH length was 20.3 ±2.4mm in the inverted V shape, 21.5±2.1mm in the inverted U shape and 21.6±2.0mm in dumbbell-shaped SH with a p-value of 0.8. The distance between the S2 foramen and the Apex of the SH was 36.3±6.5, 34.8±5.3mm and 43.0±12.0 mm, respectively, with a P-value of. 0.001. The distance between the apex to the right superolateral Sacral crest was 59.8±10.7, 57.2±11.8 and 55.0±7.5mm, respectively, with a P-value of 0.1.
Conclusions: In adult Indians and other populations, sacrum and SH revealed morphometric differences. Understanding these variances could help caudal epidural anesthesia work better. Documenting the morphology and morphometry of the Sacral hiatus (SH) will provide valuable information in understanding its role in CEB-related complications.
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Sauliha Rafeeq
Junior resident, Department of Anatomy, Government Medical College Srinagar, J&K, India
Ghulam M Bhat
Professor, Department of Anatomy, Government Medical College Srinagar, J&K, India
Shahid Kaleem
Junior resident, Department of Anatomy, Government Medical College Srinagar, J&K, India
Insha Majeed
Junior resident, Department of Anatomy, Government Medical College Srinagar, J&K, India
Shazia Afzal
Junior resident, Department of Anatomy, Government Medical College Srinagar, J&K, India