Epidural Needle

When the epidural needle is passed anterior to the ligamentum flavum, the injected air or saline can easily enter the plane between the nonadherent dorsal fat pad and the canal wall. This is the "loss of drag" noted when the syringe plunger suddenly yields to the pressure applied during needle advancement. Solutions or air injected into the epidural space are easily distributed between the surfaces of various structures and surround the dura mater, with only occasional obstructions in the dorsal midline where the dura mater may adhere to the lamina or fat. Less commonly, the needle may get into the material of the back fat pad, making it difficult for the catheter to pass. If the needle enters the spinal canal lateral to the midline, it may encounter the dura without further advancement because the dorsal epidural fat pad may be very thin at its lateral attenuation. For this reason, needle rotation should be avoided as it increases the chance of penetration of the dura at the puncture site.

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