Epidural Block of the Lumbar and Sacral regions


Our preferred technique for the epidural block

The patient is positioned in sternal recumbency with the ischiatic tuberosities on the operating table, the hips flexed and the calcaneal tuberosities on the table and  adjacent to the thorax.


On the sagital line we have drawn : the spinous processes of L6, L7 (without annotation) and S2; on both sides of the spinous process of L7, the sacral tuberosities.

Click the link bellow of a video demonstration. You can read the explanation on the last paragraph of this text. 


After identifying these landmarks we leave a finger over the spinous process of S2 (usually more dorsally projected than the S1 process). Maintaining sagital line orientation and a small distance craneal to the finger (this distance is dependent on the animal's size) we introduce the needle with a 90 degree angle to the skin until it touches the lamina of the sacrum (not favouring a needle trajectory that allows direct entrance to the spinal canal).
Next we "feel" this lamina by removing the needle a little bit and angulating it's direction so as to touch the lamina again a bit more craneal than the previous spot. We repeat this manoeuvre until the ligamentum flavum is reached and perforated. Aditionally to the sensitive feedback we get from the needle, we also have direct visualization of the needle descending one level from the lamina to the vertebral canal.
We use a quincke point spinal needle. Excessive force must be avoided when the point touches bone so that it is not damaged.




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