[glfharris]

I'm a doctor training in anaesthesia. The idea with epidurals is to introduce local anaesthetic outside the compartment where the spinal cord is, literally epi-- --durally.

To sample the CSF, or to give a spinal anaesthetic, the needle needs to be introduced into the subarachnoid (one of the membranes that surrounds the central nervous system) space, but at a level below where the spinal cord has terminated. This is why they're done in the lower back typically.

Bending over is a totally legitimate way to perform them, and doesn't really alter the complication rate, while making the procedure easier. Also, there isn't really any realistic option to perform them in real time with imaging guidance. The author is right in that larger cutting needles are associated with increased rates of PDPH.

[legalnomads]

Hi there, thank you for the comment. Yes, bending over is a legitimate way to perform them, but some leak experts theorize that it can contribute to additional issues (e.g. an arachnoid bleb, which needs surgical intervention as EBPs won't suffice for treatment).