The first approach takes a very simple view, in this approach LA is deposited just behind the carotid sheath at the level of the carotid bifurcation (Figure 10). The injection is not as deep as described for classical deep cervical plexus block. Even though there are no publications based on this approach, combined with superficial plexus block, this might work very well. The advantage of this approach is the simplicity and safety. It is important to visualize the needle tip through out the procedure and aspirate before each injection so that intra-vascular injection into the carotid or the internal jugular can be avoided.
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.