How to Perform a Coccygeal Nerve Block in a Cat

How to perform a coccygeal nerve block in a cat

In this guide, we’ll walk you through how to perform a caudal epidural, also known as a sacral coccygeal block, in cats.

This procedure is particularly useful in cats with urethral obstructions as it helps relax the urethra and provides effective regional anesthesia to areas like the perineum, penis, urethra, colon, and anus.

By targeting the pudendal, pelvic, and caudal nerves, this block reduces the need for intravenous anesthesia, which is a huge benefit for these patients.

Why Use This Procedure?

A 2018 study published in JVEX confirmed that this technique is safe and helps lower the amount of anesthesia required for cats, especially during procedures involving the lower urinary tract. It’s an excellent tool for managing pain and easing catheterisation in cats with urethral obstruction.

How to perform the block

Positioning the cat:
Start by placing the cat in sternal recumbency (lying on its belly). This is the most stable and convenient position for the procedure.

Locating the injection site:
You must palpate the space between the sacrum and the first coccygeal vertebra (or sometimes the space between the first and second coccygeal vertebrae). The easiest way to do this is by gently moving the tail up and down while applying pressure on the spine in that region. The most mobile joint will be the correct spot for the injection.

Choosing the right needle:
For this procedure, we use a 25-gauge needle about 1.5 inches long. You’ll attach it to a 1 mL syringe, which will contain 0.22 mg per kg of bupivacaine. Typically, this works out to around 0.2 to 0.3 mL per cat, depending on their size.

Administering the injection:
Once you’ve located the most mobile joint, insert the needle perpendicular to the spine at about a 30 to 45-degree angle. As you advance the needle, you’ll feel a slight “pop” when you pass through the ligamentum flavum, which confirms you’re in the correct space. If you hit bone, don’t worry. You can gently walk the needle forward or backward until you find the right spot.

Aspirating and injecting:
After placing the needle, aspirate to ensure no air or blood. If everything looks good, slowly inject the bupivacaine into the space.

Once the block is administered, you should see a noticeable reduction in tail and perineal responses within 10 minutes. Bupivacaine typically provides good pain relief for 10 hours in most cats, making it an excellent option for procedures requiring longer-lasting analgesia.

This procedure has a 70-80% success rate and is generally well-tolerated by cats. If performed correctly, it can significantly improve the comfort and recovery of your feline patients.

For further details or more instructional videos on feline procedures, explore our educational resources at Cat Specialist Services.

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In an emergency, please contact your local vet.

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