Question: How do you choose an appropriate level of insertion for an epidural?

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Question: How do you choose an appropriate level of insertion for an epidural?

Answer:

Because the dura is not breached, epidural insertion can be performed above L2. This is an important difference from spinal anaesthesia. Epidural anaesthesia can be performed in the lumbar or thoracic region and, in experienced hands, even in the cervical region. In the sacral region, epidural anaesthesia is termed caudal anaesthesia and is discussed later in the session.

The level of epidural insertion is determined by the intended site of surgery. For instance, for lower limb or lower abdominal surgery, a low lumbar epidural will suffice. For upper abdominal surgery, a low thoracic epidural may be more useful. For thoracic surgery, a high to mid thoracic epidural will be needed.