Eyes on the needle: Identification and confirmation of the epidural space

Epidural catheters are used to provide effective intraoperative and postoperative analgesia. Standard epidural catheterization techniques rely on palpation of surface anatomy and the experience of the anesthesiologist. Failure to correctly place an epidural catheter can lead to inadequate analgesia and serious complications, such as dural puncture headache. Exciting new devices and techniques are being developed for identification of the epidural space and confirmation of catheter entry. This article reviews and describes the recent research findings. The devices and techniques are categorized into three sections: devices that modify the loss of resistance technique; visual confirmation using the epidural needle; and confirmation of placement of the epidural catheter.