Is it necessary to rotate the epidural needle to obtain successful sacral segment block?

The effect of rotating the level of touhy needle to obtain successful sacral blockade was controversial. During the rotation, dural puncture was reported by some studies. In our study, we divided forty patients into two groups randomly. They all belonged to ASA I-II, receiving epidural needle insertion at L 2-3 epidural space, before epidural catheter was inserted. Total of 10 mL of 2% xylocaine was injected into the epidural space. In group A, the level of Touhy needle was pointed upward, that is, parallel to the ligament flavum. In group B, the level was pointed caudally. We determined the cutaneous extension of loss of cold sensation by using a swab of cotton wool soaked with alcohol 15 min and 25 min after the test injection. Our result showed no different in loss of cold sensation in sacral area between these two groups. So we concluded that there is no need to rotate the epidural needle for sacral blockade.