Hand position for epidural anesthesia technique

This graphic shows several possible hand positions for advancement of an epidural needle.

 A. The thumb and index finger of the non-dominant hand are used to grasp the shaft of the epidural needle near the patient's back, and are used to advance the needle incrementally or continuously. The thumb of the dominant hand is used to apply intermittent or continuous pressure on the syringe barrel to assess for loss of resistance.

B. The non-dominant hand stabilizes the needle and syringe against the patient's back, while the thumb and index finger are used to grasp the hub of the needle. The needle is advanced continuously or incrementally, while the thumb of the dominant hand is used to apply intermittent or continuous pressure on the syringe barrel to assess for loss of resistance.

C. The third through fifth fingers of both hands are used to stabilize the needle relative to the patient's back, while the epidural needle wings are grasped with the thumbs and forefingers. The needle is advance incrementally. Between advancements, the thumb of the dominant hand is used to apply pressure on the needle barrel to assess for loss of resistance.

For further information, refer to UpToDate content on epidural and combined spinal epidural technique.