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.
Side effects and drug interactions with cyclosporine are common, and some may be life-threatening. Thus, patients receiving therapy must be carefully monitored for electrolyte abnormalities, nephrotoxicity, hypertension, neurotoxicity, and infections. Prophylaxis against PCP during therapy is required. The side effects of cyclosporine, drug interactions, and strategies to minimize toxicity are discussed in detail separately. (See "Pharmacology of cyclosporine and tacrolimus" and "Treatment and prevention of Pneumocystis pneumonia in HIV-uninfected patients" .)
Natural progesterone may be a more effective treatment. In a study of 25 women with catamenial exacerbation of complex partial seizures of temporal lobe origin, 72% of the women improved. The average decline in seizure frequency was 55%. Of the 25 women in the study, 14 had anovulatory cycles or an inadequate luteal phase. These women took progesterone lozenges (200 mg tid) on days 15 through 25 of each menstrual cycle, with taper over days 26 through 28. The 11 women with normal cycles and perimenstrual seizure exacerbation took the same type and dose of progesterone on days 23 through 25 of each menstrual cycle.