BACKGROUND: There is an increasing interest in regional anesthesia for pediatric patients, in particular, the efficacy of the caudal approach is similar to that of lumbar epidural anesthesia, and reduces the risk of damage to the spinal cord and vessels. Although caudal catheterization may increase the likelihood of urofecal contamination, especially in children who are not toilet trained, no significant infection has been reported after caudal epidural catheter indwelling. The purpose of this study was to clarify the anatomic characteristics of the sacrococcygeal area in children by comparing the anthropometric variables of children and adults, and to reconsider the caudal epidural catheter safety with respect to fecal contamination.

METHODS: Thirty-eight children aged 3-9 years and 47 adults aged 30-75 years, without bony deformities, were enrolled in this study. In left lateral position, Tuffier's line (A), sacral hiatus (B) and greater trochanter (C) were marked. The shortest distances from A to B, from A to C and from B to the anus (D) were measured and the ratios of BD to subject height, BD to AB and BD to AC were calculated.

RESULTS: The shortest AB, AC and BD distances were significantly shorter in children and conversely the ratios of BD/height, BD/AB and BD/ AC were significantly larger.

CONCLUSION: Considering anatomical characteristics of pediatric patients, if a child is toilet trained and the catheter insertion site is well sealed, there should be no difference between the incidence of infection in adults and children after caudal epidural catheter indwelling.