In this issue of the Journal, Dugani et al} present a case concerning a patient undergoing a caudal block for chronic pain treatment wherein a bowel hernia, inferoposterior to the coccygeal ligament, was found incidentally using fluoroscopy and confirmed with ultrasound. The initial procedure was abandoned, and subsequently, the patient underwent coccygeal hernia repair. In this case, Dugani et al. raise two important issues in both chronic pain management and ultrasound-guided regional anesthesia, namely, "incidental detection" and "the capability of ultrasound to identify nonneural pathology", that are more notable than the authors' ability to define the pathological condition and modify patient management using ultrasound and fluoroscopy. Undoubtedly, the continuing popularity of ultrasound techniques in regional anesthesia will result in the exposure of anesthesiologists to these issues; in fact, an increasing number of such cases are reported in many journals. However, when it comes to diagnosing pathology using ultrasound, most anesthesiologists lack training and experience. Collaboration with radiologists and formal training in ultrasound are considerations for equipping anesthesiologists to take advantage of the possibilities offered by imaging technologies.
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