Epidural Catheter Placement Techniques by Anesthesia Residents: Success and Complications (EPİ-TECH)

Marmara University Pendik Training and Research Hospital

Status: Not yet enrolling

Conditions: Graduate Medical Education; Medical; Postoperative Pain; Education; Epidural Anesthesia; Catheterisation

Treatments: Procedure: epidural catheter placement

Study type: Observational

Funder types: Other

Identifiers

NCT07573007

mü anesthesia

Details and patient eligibility

About

This prospective observational study aims to evaluate the impact of epidural catheter placement techniques - loss of resistance (LOR) and hanging drop (HD) - on first-attempt success rates and procedural complications among anesthesia residents. Residents with at least two years of training will perform epidural catheterization under supervision for patients scheduled for elective surgery requiring perioperative epidural analgesia. An independent observer will record procedural details, complications, and postoperative pain scores. The study will enroll 440 patients aged 18-80 with ASA I-III classification.

Full description

Epidural catheterization is a cornerstone technique in perioperative and obstetric pain management. Two established methods are commonly used to identify the epidural space: the loss of resistance (LOR) technique, using air or normal saline, and the hanging drop (HD) technique. Although both are widely employed, comparative data on their performance by residents in training are limited. This study prospectively observes which technique the resident chooses, records procedural parameters (depth of epidural space, number of attempts, level of insertion), and documents immediate complications (dural puncture, intravascular placement, paresthesia, hypotension) and postoperative outcomes (NRS scores at 0, 6, 12, and 24 hours; PDPH). Cases in which a resident is unable to complete the procedure are documented separately, including the reason for failure and subsequent management by a supervising specialist. All procedures are performed using an 18G Tuohy needle and standard catheter set. A test dose is administered to all patients following catheter placement. Data are recorded by an independent observer using a standardized data collection form.

Enrollment: 440 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18-80 years
• ASA physical status I, II, or III
• Scheduled for elective surgery requiring perioperative epidural analgesia or anesthesia (lumbar or thoracic approach)
• Epidural catheter to be placed by a resident with ≥ 2 years of anesthesia training

Exclusion criteria

• Spinal deformity (scoliosis, kyphosis, or prior spinal surgery at the target level)
• Coagulopathy or anticoagulant therapy precluding neuraxial blockade
• Active infection at the insertion site or systemic infection
• Pre-existing neurological disease affecting the spinal cord or nerve roots
• Emergency surgery
• History of prior failed epidural catheterization
• Patient refusal or inability to provide written informed consent
• Local anatomical pathology precluding safe epidural access

Trial design

440 participants in 2 patient groups

Loss of Resistance (LOR) Group

Description:

Patients in whom the epidural space is identified using the loss of resistance technique. The attending resident uses a syringe filled with air or normal saline attached to the Tuohy needle hub and advances until resistance disappears upon entering the epidural space.

Treatment:

Procedure: epidural catheter placement

Hanging Drop (HD) Group

Description:

Patients in whom the epidural space is identified using the hanging drop technique. A drop of normal saline is placed at the Tuohy needle hub and observed to be aspirated inward by the negative epidural pressure as the needle tip traverses the ligamentum flavum.

Treatment:

Procedure: epidural catheter placement