How to Perform a Sacrococcygeal Block in a Cat

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January 2025

In this VETgirl online veterinary continuing education video, we demonstrate how to perform a sacrococcygeal (SC) epidural (aka – “SC block”, “caudal block”, “coccygeal block”) in a cat. The SC epidural can provide regional analgesia for procedures involving the tail, penis, or vulva. In sternal recumbency, an approximately 4 x 4 cm square just proximal to the base of the tail is clipped and aseptically prepared. The sacrococcygeal space is appreciated via digital palpation (with sterile gloves) for the dimple created when an assistant repeatedly flexes and lowers the tail – the coccygeal vertebrae will move whereas the sacrum will not and creates a hinge as the tail is flexed. A 25-gauge, 1 inch needle is inserted into this space on midline. A gentle pop may be appreciated when the ligamentum flavum has been penetrated. If you feel bone with the needle (e.g., the bone is encountered at a superficial depth), walk the needle cranially or caudally until it sinks into the intervertebral space. If bone is encountered at a subjectively deeper depth, the needle may have advanced through to the floor of the vertebral canal and should be withdrawn and repositioned. Next, aspirate to confirm the presence or absence of blood – aspiration of blood would necessitate removal of the needle and reattempt placement with a new needle. Once in position, administer your anesthetic (commonly 0.1-0.2 mL/kg 2% lidocaine or 0.22 mg/kg 5% bupivacaine; we recommend using a new, preservative-free formulation/bottle if available) up to a maximum volume of 0.2 mL/kg with an average maximum volume for SC block in cats of 0.5 mL/cat.1,2 There should be little resistance encountered with administration of the anesthetic. An effective SC block should result in a relaxed tail and perianal area. Depending on the drug administered, onset of effect should occur within 5-20 minutes and with a duration of 2-3 hours.3,4 NOTE: This demonstration utilizes medical specimens for instructional purposes.

Don’t have time to watch the video? Listen to this blog  on placing a sacrococcygeal epidural in a cat or watch this additional VETgirl video HERE on sacrococcygeal blocks in cats.

This specialized education is brought to you by an exclusive partnership between VETgirl and the BluePearl EmERge program. The BluePearl EmERge program is an immersive emergency veterinarian training program, putting you on the fast track to becoming a highly experienced, confident, and capable emergency veterinarian, ready to provide lifesaving care for pets in need. The program gives you everything you need for a successful career in emergency medicine, including the critical, hands-on experiences, immersive training and personal mentorship needed to thrive. The EmERge program is for new graduates or practicing veterinarians interested in transitioning to emergency medicine. For more information about the program visit https://careers.bluepearlvet.com/us/en/emerge-program.

References:
1. O’Hearn AK, Wright BD. Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction. Journal of Veterinary Emergency and Critical Care. 2011 Feb;21(1):50-2.
2. Pratt CL, Balakrishnan A, McGowan E, Drobatz KJ, Reineke EL. A prospective randomized, double‐blinded clinical study evaluating the efficacy and safety of bupivacaine versus morphine‐bupivacaine in caudal epidurals in cats with urethral obstruction. Journal of Veterinary Emergency and Critical Care. 2020 Mar;30(2):170-8.
3. Cruz ML, Luna SP, Clark RM, Massone F, Castro GB. Epidural anaesthesia using lignocaine, bupivacaine or a mixture of lignocaine and bupivacaine in dogs. Journal of Veterinary Anaesthesia. 1997 Jul 1;24(1):30-2.
4. de Segura IA, Menafro A, García-Fernández P, Murillo S, Parodi EM. Analgesic and motor-blocking action of epidurally administered levobupivacaine or bupivacaine in the conscious dog. Veterinary Anaesthesia and Analgesia. 2009 Sep 1;36(5):485-94.

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