Evaluation of M43B Lumbar puncture simulator-II as a training tool for identification of the epidural space and lumbar puncture.

The identification of the epidural space, insertion of an epidural catheter and lumbar puncture are advanced technical skills that can be challenging to teach to novice anaesthetists. The M43B Lumbar puncture simulator-II (Limbs & Things Ltd., Sussex Street, Bristol, UK) is a teaching aid designed for epidural and spinal insertion. The aim of this study was to determine if experienced anaesthetists thought this simulator may be a useful tool for training novice anaesthetists in these procedures. Experienced anaesthetists performed an epidural insertion followed by a lumbar puncture procedure on the simulator model. Various aspects of both epidural and lumbar puncture insertions were scored by the anaesthetists for likeness to a real patient using a Likert scale (0--strongly disagree; 1--disagree; 2--neither agree nor disagree; 3--agree; 4--strongly agree). The simulator was found to be life-like for most aspects of epidural insertion. Median (IQR [range]) scores were: iliac crests 3.0 (3.0-3.2 [3-4]); spinous processes 3.0 (3.0-3.2 [2-4]); skin puncture 3.0 (3.0-3.0 [1-4]); subcutaneous tissues 3.0 (2.7-3.0 [1-4]); and loss of resistance 3.0 (3.0-4.0 [3-4]). The scores for supraspinous ligament 2.0 (1.0-3.0 [0-3]), interspinous ligament 2.5 (1.7-3.0 [0-3]) and ligamentum flavum 2.0 (1.0-3.0 [0-4]) were borderline for life-likeness. The volunteers found threading of the epidural catheter difficult and rated it unlike a real patient (score 1.0 (0.2-2.0 [0-3])). During lumbar puncture, dural puncture scored 3.0 (3.0-4.0 [2-4]) and intrathecal injection scored 2.5 (1.0-3.0 [1-4]). However, the overall impression was that the simulator could be a useful tool for training of both epidurals (score 3.0 (3.0-4.0 [3-4])) and spinals (score 3.0 (3.0-3.5 [2-4])).