The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.
Initial dose: 100 mg orally once a day. This dosage may be divided into two daily doses, and increased as tolerated every two to three days to a maximum recommended total daily dose of 400 mg. It is recommended that the dosage be titrated to decrease sodium retention, hypertension, weakness, hypokalemia, and any other signs or symptoms of primary hyperaldosteronism in this patient.
If this patient has an adrenal adenoma or carcinoma, the lowest possible spironolactone dosage should be given while waiting for surgery. Adrenal hyperplasia, however, usually does not respond to surgery, and chronic spironolactone therapy is recommended.
Patients with adrenal hyperplasia often require other antihypertensive therapy to control their associated hypertension.