The technique of intervertebral epidural anesthesia in children is the same as in adults. A loss of resistance is used to identify the epidural space (rather than a “hanging drop”).
In children weighing more than 10 kg, the distance from the skin to the epidural space (in millimeters) is approximately equal to the weight of the child (in kilograms). That is, a 20-pound child, this distance is approximately 20 mm. For children under 2–3 years old and with a body weight less than 10 kg, no inter vertebral approach is used. For children under 5 years old, use a 19-gauge Tui needle and a 21-gauge catheter; and for children over 5 years old – an 18-gauge needle and a 20-gauge catheter. Doses of local anesthetic are less predictable with lumbar access than with caudal.