Thoracic epidural catheters provide superior postoperative analgesia but are technically challenging to place, with failure rates up to 30% using standard loss-of-resistance (LOR) techniques. Fluoroscopic confirmation (FC) is the gold standard, yet not widely available. This study evaluates whether epidural waveform analysis (EWA) can reliably confirm needle and catheter placement compared with FC. Using a pressure transducer system and waveform acquisition hardware, EWA was tested in 160 participants. Preliminary data show that waveform presence correlates strongly with successful epidural placement, with early analyses suggesting EWA may outperform LOR alone and approach the accuracy of FC. Differences between needle-based and catheter-based waveforms highlight the importance of fluid dynamics in interpretation. Ongoing analyses aim to calculate positive and negative predictive values of EWA relative to FC and evaluate trainee comfort using EWA. If validated, EWA could serve as an accessible, low-cost confirmation method in settings lacking fluoroscopy.