The tapping technique in epidural anesthesia is an approach that some anesthesiologists use to improve the precision and efficacy of epidural placement. Epidural anesthesia, commonly used for pain relief in surgical and obstetric procedures, relies on the successful delivery of local anesthetics into the epidural space. Although loss-of-resistance techniques are traditionally used to confirm proper needle placement, approaches such as the tapping technique may improve procedural accuracy and reduce patient discomfort (1).
The tapping technique involves controlled percussive movements or gentle tapping of the needle hub to incrementally advance the needle toward the epidural space. This method allows the anesthesiologist to feel subtle changes in resistance, which improves tactile feedback. Studies suggest that this approach minimizes the risk of dural puncture and inadvertent intravascular injection by providing more controlled and gradual needle advancement compared to continuous manual pressure (2). In addition, the tapping technique has been associated with a higher first-pass success rate, particularly in patients with challenging anatomical characteristics such as obesity or spinal deformity.
Comparisons between the tapping technique and loss-of-resistance methods for epidural anesthesia have yielded mixed results. Some studies suggest that the tapping approach reduces procedure time and improves the accuracy of epidural catheter placement, particularly in the thoracic region. Other studies have reported no significant difference in patient outcomes but suggest that the tapping technique may increase operator confidence and reduce the frequency of failed attempts (3). A major advantage of this method is the reduced likelihood of accidental dural puncture, which is a major cause of post-dural puncture headache. This has made the tapping technique particularly useful in obstetric anesthesia, where minimizing discomfort and complications is critical.
A study examining postoperative pain management in abdominal surgery found that patients who received epidural anesthesia using the tapping technique required less opioid analgesia than those who underwent traditional loss-of-resistance techniques (4). This suggests a potential benefit in achieving more effective pain control, thereby reducing opioid-related side effects. In addition, the tapping technique appeared to provide better local anesthetic distribution, resulting in a more uniform sensory blockade. This may be particularly beneficial in complex surgical cases requiring prolonged analgesia, such as colorectal or gynecologic cancer surgery.
Despite these advantages, the tapping technique is not without limitations. It requires advanced training and experience to recognize the subtle tactile cues necessary for successful placement. In addition, while some anesthesiologists find it beneficial, others report that it does not significantly improve their practice compared to traditional methods. Patient-specific factors, such as anatomical variations or prior spinal surgery, may also influence the effectiveness of the tapping technique. Further research, including randomized controlled trials, is needed to determine the long-term benefits and to standardize training protocols for implementation in clinical practice (5).
The tapping technique is an approach to epidural placement methods that is preferred by some clinicians. While it may not completely replace conventional techniques, it serves as a valuable adjunct for experienced practitioners seeking to refine their approach. As research continues to explore its efficacy, tapping may become an integral component of modern epidural anesthesia practice, particularly in high-risk patient populations.
References
- Vereen MS, Bidault VJ, Krabbendam E, et al. The effectiveness of liposomal bupivacaine in ultrasound‐guided abdominal wall blocks after open abdominal surgery: A systematic review. Pain Med. 2025.
- Sidyuk OY, Khomenko OY, Borysenko AO, et al. Comparison of epidural anesthesia and TAP block for pain relief in colorectal surgery. Ukrainian J Surg. 2025.
- Singhal S, Bala M, Kaur K. Identification of epidural space using loss of resistance syringe, infusion drip, and balloon technique: A comparative study. Saudi J Anaesth. 2014;8(Suppl 1):S41-S45. doi:10.4103/1658-354X.144070
- Majeed A, Abdelgadir NE, AlFattani AAG, et al. Evaluation of acute postoperative pain management after living donor nephrectomy during the transition from open access to laparoscopic and minimally invasive robotic surgical approach. Saudi J Anaesth. 2025;19(1):39-44. doi:10.4103/sja.sja_425_24
- Senapathi TGA, Kurniyanta IP, et al. Continuous caudal anesthesia in children undergoing surgery: A systematic review. J Emerg Trauma Acute Care. 2024.