Blind caudal epidural injection for sciatica in resource-limited practice: a narrative review

Sciatica is a common and disabling condition often resulting from lumbar disc pathology, with epidural steroid injections representing an established option when conservative treatment fails. Among the three principal epidural approaches, caudal epidural injection (CEI) is the oldest and technically simplest technique. While contemporary practice increasingly favors image-guided and more targeted approaches, blind CEI remains clinically relevant in selected settings. This narrative review examines the anatomical basis, technique, safety profile, and evolving role of blind CEI in the management of low back pain and sciatica. Particular attention is given to its favorable safety characteristics, largely related to its anatomical trajectory, which avoids close proximity to the spinal cord and major radicular arteries. Serious complications are rare, and minor adverse effects are typically transient and self-limiting. Blind CEI can be performed without radiological guidance, which makes it a practical option in outpatient clinics, emergency departments, and other low-resource or technically limited settings. In such environments, it may offer a reasonable and accessible therapeutic intervention when imaging-based techniques are unavailable.

Injections, Epidural; Sciatica; Low back pain; Physical and rehabilitation medicine

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