Caudal Shot (Regional)

Last updated: February 9, 2026

Indication

for post-op pain control for sub-umbilical surgeries (circumcision, anal surgeries)

Position

Left lateral decubitus. Identify PSIS (2), sacral cornua (2), coccyx (1), and the sacral hiatus (1). It forms a triangle and aim is midline.

Steps

Palpate to ensure no abnormalities (dimpling, weird hair tufts, etc). Aiming for sacral hiatus. Dural sac ends S2-S3, so avoid that level. Palpate the cornu (coccyx is one point, and then cephalad to that is the 2 sacral cornu). Insert at a 45 (parallel to floor), hit os (coccyx), then flatten to 0 or even –10. Advance through sacrococcygeal ligament. You may feel a pop or not. Aspirate.

When injecting, swelling should expand and then return to flat as medication enters. If SubQ, it will stay expanded. Monitor EKG for changes and T wave appearances (intravascular)

Needles and Meds: Use a 22 Gauge 1.5 inch needle. Or a 22 gauge IV catheter.

0.2% ropivacaine plain. Or 0.25% bupivacaine with 1:200,000 epinephrine.