Epidural needle insertion paramedian approach

Schematic of thoracic epidural catheter placement using transverse and posterior views of drawings of the thoracic spine.
(A) The epidural needle is inserted 1 cm lateral to the spinous process of the targeted segment and advanced until the lamina is contacted. If lamina is not contacted, avoid advancing the needle laterally, which will place the needle in the paravertebral space. Note the needle depth to the lamina.
(B) Withdraw the needle slightly, and redirect approximately 15 degrees medially and 45 degrees cephalad.
(C) Advance the needle, walking the tip off the lamina. Stop needle advancement as soon as the ligamentum flavum is felt.