Saddle anesthesia, or caudal anesthesia, refers to numbness around the groin, across the buttocks and through the perineum, the flesh between the buttocks. When it occurs spontaneously, it can be a sign of damage to the spinal cord, and may be a symptom of a medical emergency. It can also be induced by an anesthesiologist for a medical procedure. In both cases, some neurological testing can be used to determine the extent of the loss of sensation.
Spontaneous development of saddle anesthesia is often associated with cauda equina syndrome. This medical condition occurs as a result of damage to the nerve roots at the base of the spinal cord. They are known as the “cauda equina” or “horse’s tail” because of their appearance, and most commonly experience injuries as a result of a herniated disc. If this condition is not treated, it can cause paralysis. Patients can also develop incontinence and other problems.
In addition to causing saddle anesthesia, this condition can contribute to weakness, incontinence, and poor coordination of the legs. A medical imaging study may reveal damage to the spinal cord, while a physical exam can provide more information about the specific nerve roots involved. The patient may need immediate surgery to decompress the spinal cord and prevent permanent damage. After surgery, recovery may involve resting along with physical therapy to redevelop strength and coordination while protecting the spine.
The saddle block is an anesthesia technique care providers may recommend for some procedures around the groin area. One reason to use saddle anesthesia is in an episiotomy, where a doctor cuts into the perineum to facilitate delivery of a baby. This can be quite painful, and anesthesia is required to keep the patient comfortable. Anesthesiologists may recommend saddle anesthesia for other procedures involving the perineum, such as drainage of abscesses around the anus.
To perform a saddle block, the anesthesiologist carefully prepares the patient’s lower back, wiping it down with antiseptics to reduce the risk of infection. A needle can be used to numb the area before inserting a larger needle to numb the spinal cord. Pain signals will no longer move up the spine, allowing care providers to continue with a procedure. Typically, the doctor recommends a brief waiting period and a check to make sure the anesthesia has taken effect before proceeding, to reduce the risk of causing pain and distress by starting while the patient still has sensation.