# Effective Pain Relief Following Caudal Epidural Block in a Pediatric Patient with Traumatic Sacrococcygeal Dislocation: A Case Report

## TL;DR

A 14-year-old girl with persistent pain from a rare tailbone injury found significant relief after a caudal epidural block, a treatment not previously reported in children with this condition.

## Contribution

First reported use of caudal epidural block in a pediatric patient with traumatic sacrococcygeal dislocation.

## Key findings

- The patient's pain decreased from NRS 6 to NRS 2 after the caudal epidural block.
- Functional improvement was observed two weeks and two months post-procedure.
- The procedure was performed safely using ultrasound guidance with mepivacaine and dexamethasone.

## Abstract

Background and Clinical Significance: Sacrococcygeal joint dislocation is an extremely rare traumatic condition in the pediatric population and is typically caused by direct trauma to the gluteal region. Most reported cases have been managed conservatively with analgesics or manual reduction, and the application of a caudal epidural block in children with this entity has, to our knowledge, never been previously described. Case Presentation: A 14-year-old girl presented with aggravated coccydynia following a second fall. Six months earlier, she had been diagnosed with sacrococcygeal dislocation after her initial fall, and her symptoms had been well controlled at a Numerical Rating Scale (NRS) score of 3 with acetaminophen and nonsteroidal anti-inflammatory drugs. However, after the recent reinjury, her pain worsened to an NRS score of 6 and did not improve despite continued conservative pharmacologic treatment. Radiographic examination at our institution confirmed anterior angular displacement of the coccyx. Accordingly, an ultrasound-guided caudal epidural block was performed using mepivacaine and dexamethasone. At follow-up evaluations conducted 2 weeks and 2 months after the procedure, her pain had decreased to an NRS score of 2, accompanied by functional improvement. Conclusions: This case suggests that caudal epidural block may serve as a safe and potentially effective therapeutic option for pediatric patients experiencing coccygeal pain following traumatic sacrococcygeal joint dislocation.