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Medications and their breakdown by-products make their way into the water supply. A 2000 study by the US Geological Survey found residues from antibiotics, birth control pills, hormone replacement therapy, painkillers, chemotherapy agents, and antidepressants in 80% of streams sampled. 18 The true extent of the problem is not known, but it is known that most pharmaceuticals pass into human waste unchanged, and that many drugs, such as oestrogens, may persist in the groundwater for years, Pharmaceuticals can be removed by UV light and carbon filters.
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.