Many common surgical techniques can be conducted with lumbar epidural anesthesia as the sole anesthetic. Many factors influence whether it should be chosen over general anesthesia or another type of regional anesthesia. The less frequently used paramedian approach to the central neuraxis offers several advantages, particularly in patients without palpable landmarks, and/or in patients who are unable to flex because of arthritic or painful comorbid conditions. Specific details of using lumbar epidural anesthesia as the sole anesthetic is illustrated in three common clinical conditions: total abdominal hysterectomy, lumbar laminectomy, and femoral-popliteal bypass.