Using LOR Syringe Probes as a Method to Reduce Errors in Epidural Analgesia - a Robotic Simulation Study

In epidural analgesia, anesthetics are injected into the epidural space, to block signals from traveling through nerve fibres in the spinal cord or near it. To do so, the anesthesiologist inserts a Touhy needle into the patient’s skin and uses it to proceed to the epidural space, while using the haptic feedback received from a ”loss of resistance” (LOR) syringe [1] to sense the environment stiffness and identify loss of resistance from potential spaces. The two most common errors or complications of epidural analgesia are failed epidurals (FE) – halting the needle insertion in a superficial location, which will cause no pain relief – and accidental dural punctures (ADP), leading in most of the cases to post dural puncture headache (PDPH). The task of identifying the epidural space correctly and stopping the needle insertion while in it is challenging mechanically, and requires extensive training [2]. Hence, robotic simulation is an attractive method to help opti- mize skill acquisition [3]. Another advantage of robotic simulation is the ability to record kinematic information throughout the procedure, to evaluate users’ performance and strategy. In this study, we used a bimanual robotic simulator that we developed in previous work [3] to an- alyze the effect of LOR probing strategies on procedure outcomes.