"Don't turn the needle!"

Accidental dural puncture is a well-recognised complication of epidural anaesthesia. The technique of inserting the epidural needle with the bevel parallel to the spinal ligaments is still taught in some centres. Evidence is presented that the subsequent turning of the needle to allow passage of the epidural catheter may increase the likelihood of dural puncture. There would also appear to be a greater chance of subdural catheterisation. The epidural needle should be introduced with the bevel in the direction in which the catheter is to go and not moved once the epidural space is located.