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Background and Aims Epidural analgesia relies on the perception of the loss of resistance for needle placement in the epidural space. The ability to detect the loss of resistance may vary, which can lead to unintended dural punctures. This study aimed to determine the incidence of self-reported technical challenges encountered by trainees during epidural analgesia and whether the year of training predicts difficulty.

Methods We conducted a retrospective analysis of medical records from parturients receiving epidural analgesia by anesthesiology trainees between March 1 and April 30, 2024. All trainees received theoretical and hands-on simulation training. We documented self-reported technical challenges, bone contact, number of attempts as well as trainees’ level of training and patient characteristics. As per protocol, all patients were assessed for post-dural puncture headache the day after the epidural insertion.

Results Out of 146 epidurals performed by 26 trainees, 15 attempts (10%) were perceived as challenging, with bone contact in 13 (87%) cases. Thirty epidurals (20%) required at least two attempts and 5 (3% of all punctures, 33% of difficult punctures) needed three or more attempts. Challenging punctures required at least two attempts. The most commonly reported cause of difficulty was obesity with a median BMI of 32.4 kg/m². Interestingly, challenges and bone contact did not correlate with the level of training. No dural punctures were reported.

Conclusions In this retrospective study, 10% of epidurals performed by trainees were challenging, with obesity being the most frequent cause. No correlation was found between the trainees’ level of experience and the difficulty of the epidural technique.