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Epidural Simulators: The Potato, The Banana and The Mannikin
Abstract Number: T2C-422
Abstract Type: Original Research
Epidurals are commonly performed for labour analgesia, for the treatment of chronic back pain or to provide peri-operative analgesia for major operations. 
Data from the 3rd National Audit Project of the Royal College of Anaesthetists showed that 40% of the 700,000 central neuroaxial blocks performed annually in the NHS are epidurals, with the majority being performed by anaesthetists. 
For many trainees, inserting an epidural for the first time in a patient can be very daunting and nerve-wrecking. The opportunity to be able to practice the feel of the loss of resistance technique on a model/manikin has been regarded to be extremely helpful. The development of different types of epidural simulators for this purpose have been of particular interest , including the use of basic greengrocer’s items such as root vegetables and fruits as a cheap, effective, realistic and simple alternative to the commercial epidural simulator.
Anaesthetists in our hospital were asked to compare the potato, the banana and the commercially available manikin, and to rate and compare the feel of the loss of resistance as well as the feel of the ‘ligamentum flavum’.
• 78% of anaesthetists surveyed were aware of commercial epidural simulators, and only 26% were aware of greengrocer’s items used as epidural simulators.
• Most anaesthetists use loss of resistance to saline (65%) and continuous pressure (61%).
• The feel of the loss of resistance was best in the potato (81%), followed by the manikin (78%), and then the banana (70%).
• The feel of the ligamentum flavum was best in the potato (67%), followed by the manikin (58%), and then the banana (48%).
We started this project to find the perfect epidural simulator as an educational tool to aid the teaching of performing epidurals. In conclusion, there is no perfect simulator model. But, the potato has emerged as the simulator model with the closest feel of loss of resistance and feel of ligamentum flavum to the real patient, and the ‘feel’ is better when using the loss of resistance to saline method with continuous pressure.
1. Vaughan N, Dubey VN, Wee MY, Isaacs R. A Review of Epidural Simulators: Where are we Today? Med Eng Phys. 2013 Sep;35(9):1235-50.
2. Cook TM, Counsell D, Wildsmith JAW. Major complications of central neuraxial block: report on the 3rd National Audit of The Royal College of Anaesthetists. Br J Anaesth 2009;102:179-90.