Simulation Training for Epidural Placement: A Randomized Trial Comparing the Use of an Ex Vivo Porcine Spine Model with the M43B Lumbar Puncture Simulator IIA Model

Proficiency in epidural placement remains a challenging skill for anesthesia providers, requiring the ability to discern loss of resistance (LOR) when entering the epidural space. Current educational manikins lack the tactile feedback required for realistic epidural training. This descriptive pilot study aimed to compare an ex vivo porcine spine model with the M43B manikin model for simulation of clinical epidural placement. Expert anesthesia providers (n = 10) evaluated physical characteristics of each model using a survey comprised of a visual analog scale (0-100) and qualitative open-ended questions. Continuous data were analyzed using paired two-tailed Student's t tests, while qualitative open-ended narrative responses were reported by response frequency. Epidural simulation with the porcine spine demonstrated significantly higher clinical similarity scores (P < .001) for ligamentum flavum feel (85 ± 4.5 vs. 32 ± 8.1), LOR (93.5 ± 3.0 vs. 42.5 ± 10.7), catheter insertion (92.3 ± 3.9 vs. 48.8 ± 8.0), and novice training utility (92.5 ± 3.3 vs. 41.5 ± 7.7), while landmark identification (iliac crest/spinous processes) was comparable between models. Providers unanimously preferred the porcine model for epidural simulation. Simulation using an ex vivo porcine spine model enhances the realism of epidural training and underscores the importance of utilizing clinically relevant models for anesthesia procedural skill acquisition and maintenance.