Abstract

Evidence overwhelmingly supports the use of the ultrasound technique over the landmark technique to improve first attempt success rates and reduce needle redirections during administration of neuraxial anesthesia and analgesia. The ultrasound technique enhances the provider’s ability to achieve a successful puncture in one attempt without a single needle manipulation, which is highly unlikely with the landmark technique. Conflicting evidence exists regarding the association between ultrasound use and patient satisfaction, and conclusions are unable to be drawn considering the lack of standardized tools to measure patient satisfaction across studies. Several studies found no difference in patient satisfaction between the two techniques, whereas numerous other studies found the ultrasound technique to be associated with greater patient satisfaction. Despite the results, most researchers hypothesize that the ultrasound technique is associated with greater patient satisfaction due to fewer needle adjustments.

Similar conflicting results were found pertaining to complication rates and the duration of time required to complete the block. With the exception of one study, no clinically significant difference in complication rates is observed between the two techniques. Nevertheless, ultrasound use is still recommended over the landmark technique because of its favorable safety profile and the reduced frequency of needle redirection. Critics of the ultrasound technique tend to cite that neuraxial analgesia and anesthesia can be quickly administered with the landmark technique. However, most studies found there to be no difference in overall procedure time.

Author Details

Hays C. Lollis, DNP, SRNA. Hays Lollis anticipates completion of Samford University’s nurse anesthesia track of the Doctor of Nursing Practice (DNP) program on May 1, 2026. Her DNP project was titled Ultrasound-Guided Versus Landmark Technique for Neuraxial Anesthesia. Hays intends to begin her clinical practice at St. Vincent’s Hospital in Birmingham, Alabama in June 2026. Her primary areas of interest are opioid sparing anesthesia and obstetric anesthesia. Before beginning anesthesia school, she acquired critical care experience in the Trauma and Burn Intensive Care Unit at UAB Hospital. Hays began her undergraduate education at the University of Georgia and completed her BSN at Augusta University in Athens, Georgia.

Cassandra W. King, DNP, CRNA - Adjunct Faculty, Nursing, Samford University

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Neuraxial, Ultrasound Technique, Landmark Technique, Palpation, Anesthesia, Spinal Anesthesia

Advisor

Terri M. Cahoon

Second Advisor

Mary Beth Greenway

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-03-26

Full Text of Presentation

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Additional Files

Lollis_Abstract.pdf (182 kB)

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