Epidural Catheter Placement Techniques by Anesthesia Residents: Success and Complications

NCT07573007 | Not Yet Recruiting

• 1 other identifier: mü anesthesia
• Study Type: observational
• Target: 440
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

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

Keywords

epidural catheter; loss of resistance; hanging drop; procedural training; epidural space identification

Outcome Measures

Primary Outcomes (1)

• First-attempt success rate

  Defined as successful epidural space identification and catheter placement in a single Tuohy needle insertion attempt, without redirecting the needle.

  Time Frame: Immediately upon procedure completion

Secondary Outcomes (7)

• Dural puncture rate

  Intraoperative

• Catheter Advancement Failure Rate

  intraoperative

• Operator-Assessed Difficulty Score

  Immediately after procedure completion

• Intravascular catheter placement rate

  intraoperative

• Postoperative Pain Scores

  0, 6, 12, and 24 hours postoperatively

Study Arms (2)

Loss of Resistance (LOR) Group

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.

Procedure: epidural catheter placement

Hanging Drop (HD) Group

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.

Procedure: epidural catheter placement

Interventions

epidural catheter placement PROCEDURE

Epidural catheterization performed using an 18G Tuohy needle and standard catheter set by anesthesia residents with a minimum of two years of training, under specialist supervision. Technique selection (LOR or HD) is at the discretion of the performing resident and is not randomized.

Also known as: neuroaxial blockade

Hanging Drop (HD) Group; Loss of Resistance (LOR) Group

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Adult patients scheduled for elective/emergency surgery with planned perioperative epidural analgesia or anesthesia at Marmara University Pendik Training and Research Hospital, Department of Anesthesiology and Reanimation.

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Marmara University Pendik Training and Research Hospital: lead

Study Sites (1)

Marmara University Pendik Training and Research Hospital

Istanbul, Maltepe, 34852, Turkey (Türkiye)

Location

Related Publications (1)

• 1. Hoffmann VL, Vercauteren MP, Vreugde JP, Hans GH, Coppejans HC, Adriaensen HA. Posterior epidural space depth: safety of the loss of resistance and hanging drop techniques. British Journal of Anaesthesia. 1999;83(5):807-811. 2. Günaydın B, Tan A, Doğru O, Mutlu M, Öztürk G, Güler HG. Comparison of spring-loaded, loss of resistance and hanging drop techniques in lumbar epidural blocks. Agri. 2012;24(1):13-18. 3. Azizov S, Okcu M, Goksu H. Could the Hanging Drop Technique Be an Alternative Method to Loss of Resistance in Cervical Epidural Injections? Pain Physician. 2025;28:217-221. 4. Tran DQH, González AP, Bernucci F, Finlayson RJ. Confirmation of Loss-of-Resistance for Epidural Analgesia. Regional Anesthesia and Pain Medicine. 2015;40(2):166-173. 5. Yoshida K, Tanaka S, Watanabe K. Hanging-Drop Technique Is More Suitable for Epidural Space Confirmation in Patients With Subcutaneous Emphysema After Traumatic Multiple Rib Fractures. Journal of Cardiothoracic and Vascular Anesthesia. 2023;37(12). 6. Konrad C, Schüpfer G, Wietlisbach M, Gerber H. Learning manual skills in anesthesiology: Is there a recommended number of cases for anesthetic procedures? Anesthesia & Analgesia. 1998;86(3):635-639. 7. De Oliveira GS, Glassenberg R, Chang R, Fitzgerald P, McCarthy R. Virtual airway simulation to improve dexterity among novices performing fibreoptic intubation. Anaesthesia. 2013;68(10):1053-1058. 8. Kopacz DJ, Neal JM, Pollock JE. The regional anesthesia learning curve. Regional Anesthesia. 1996;21(3):182-190. 9. Naik VN, Devito I, Halpern SH. Cusum analysis is a useful tool to assess resident proficiency at epidural anesthesia. Canadian Journal of Anesthesia. 2004;51(7):703-708.

  BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Central Study Contacts

Dilara Göçmen, asst prof

CONTACT

+90 216 625 4545; dilara.gocmen@marmara.edu.tr

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dilara Göçmen

Study Record Dates

• First Submitted: May 1, 2026
• First Posted: May 7, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): June 1, 2027
• Last Updated: May 7, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)