DOI

10.21007/con.dnp.2025.0118

Faculty Advisor

Jordan Isaac, DNP, CRNA; Sharon Little, DNP, APRN, FNP-BC;Tracy McClinton, DNP, AG-ACNP-BC, APRN, EBP-C

Document Type

Poster

Publication Date

Spring 5-1-2025

Disciplines

Anesthesiology | Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Perioperative, Operating Room and Surgical Nursing | Quality Improvement | Surgery

Abstract

Purpose/Background

Epidural anesthesia is a cornerstone of perioperative pain management, offering effective analgesia and reduced opioid dependency. However, traditional landmark-based epidural placement (EP) techniques often result in variable first-pass success rates (FPSR) and increased risks of complications. Ultrasound-guided (USG) EP has emerged as an alternative, providing real-time anatomical visualization to improve accuracy and safety. This scoping review synthesizes evidence on the comparative efficacy of USG EP and conventional techniques in adult patients undergoing perioperative epidural anesthesia.

Methods

This review commenced September 2023 and included full-access, peer-reviewed journal articles published in English between 2014-2023. Databases searched included PubMed, CINAHL, Cochrane Library, or literature made accessible through the UTHSC Library’s Interlibrary Loan. Primarily utilized MeSH terms included: "conventional techniques," "ultrasound-guided epidural placement," and "first-pass success." Studies were selected if they evaluated USG versus conventional EP techniques, focusing on FPSR, needle passes or redirections, skin punctures, and procedural time. Articles involving pediatric populations or patients with contraindications to epidural anesthesia were excluded. Data from eight high-evidence articles, including one systematic review and seven randomized controlled trials, were analyzed.

Results

USG EP demonstrated higher FPSR, reduced needle passes and skin punctures, and improved patient satisfaction in six out of eight studies reviewed. However, procedural time was prolonged in cases involving providers inexperienced with USG techniques. These findings suggest that USG EP may offer significant advantages over conventional techniques, particularly in improving accuracy and reducing complications.

Implications for Nursing Practice

Integrating USG EP into clinical practice can enhance the quality and safety of epidural anesthesia. Its implementation may require training programs to address proficiency gaps, particularly for novice providers. By adopting evidence-based practices, anesthesia providers can contribute to better patient outcomes, reduce procedural risks, and optimize perioperative care.

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