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Updated: Apr 7, 2026

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
Abstract:
Repeated annual audit cycles revealed an unacceptable failure rate of 38%-46% in epidural analgesia for surgical patients in our organisation. Reasons for failure included unilateral block, missed segments and catheter migration. In spite of interventions to remedy the situation, the success rate could not be improved. The aim of the initiative outlined in this article was to improve the efficacy of epidural analgesia and to reduce the failure rate. We found that following the appropriate training and assessment, nurse-administered diamorphine top-ups are a safe and effective way to improve the efficacy of epidural analgesia and can be integrated into acute pain team practice.
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