Perineal and anorectal surgeries can cause severe postoperative pain and discomfort due to its dense nerve supply and sympathetic reflexes. Good postoperative analgesia is important for early rehabilitation and prevent chronic perineal or post- surgical pain. In gender re-assignment surgery, there is extensive surgical manipulation and reconstruction of the genitals and perineum leading to increased pain and discomfort.  The commonly practiced lumbar epidural block can produce inadequate analgesia and undue motor blockade, which can prevent early ambulation and rehabilitation of these patients. Hence, we aim to analyse postoperative analgesia via ultrasound guided caudal catheter for gender re-assignment surgeries in transgender patients. 

our aim is to assess the effectively of caudal analgesia via caudal epidural catheter for post-operative analgesia in gender re-assignment surgeries in Transgender patients 

Patient will be positioned in left lateral knee chest position. After strict aseptic precaution, Sonosite Xporte (Sonosite, Bothwell, WA) ultrasound system with multi-beam (compound array) capability and with high frequency linear array transducer (HFL 50, 15-10 MHz) will be used to perform the caudal block. The USG probe will be placed on the sacrum and scanned downward till the sacral hiatus is identified (Frog eye appearance). 18G touhy needle will be introduced in an out-plane approach towards the sacral hiatus and once the needle crosses the sacro-coccegyeal ligament (pop up), the skin epidural space distance will be noted and epidural catheter will be threaded till 5cms in epidural space. Distance of caudal space from skin, no of attempts to needle insertion, total duration for block performance will be documented. A test dose of 3 mL of 2 % lignocaine with 1 in 200000 adrenaline will be administered to rule out intravascular and intra-thecal placement of catheter.