Objective Evaluation of a New Epidural Simulator by the CompuFlo® Epidural Instrument

Giorgio Capogna, Alessandra Coccoluto, Emanuele Capogna, Angelica Del Vecchio, Giorgio Capogna, Alessandra Coccoluto, Emanuele Capogna, Angelica Del Vecchio

Abstract

Background: In this study, we describe a custom-made new epidural simulator, created by modifying the inner structure of a commercially available one, in the attempt to make it adequately realistic. To validate and evaluate the realism of our device, we used the Computerized Epidural Instrument CompuFlo.

Method: The Compuflo CompuFlo curves obtained from 64 experiments on the epidural simulator were compared to 64 curves obtained from a previous human study, from consecutive laboring parturients requesting epidural analgesia.

Results: Epidural simulator and human pressure curves were very similar. There was a significant difference between the drop of pressure due to false and true loss of resistance (LOR) in both the groups.

Discussion: Our simulator can realistically reproduce the anatomical layers the needle must pass as demonstrated by the similarity between the simulator and human pressure curves and the small differences of pressure values recorded. CompuFlo may be used as an objective tool to create and assess and compare objectively the epidural task trainers.

Figures

Figure 1
Figure 1
After having removed the inner length of plastic of a commercially available epidural simulator (P61, 3B Scientific), we inserted in its place a modified solid rigid polyurethane foam spinal column model. This way the vertebral arch and the other possible bony parts which may be encountered during needle insertion were present into the model in a life-like dimension and structure.
Figure 2
Figure 2
A layer of clear, transparent sealant silicone was modelled from the inferior edge and anteroinferior surface of cranial vertebra to the superior edge and posterosuperior surface of caudal vertebra to mimic the ligamenta flava.
Figure 3
Figure 3
The neoprene-silicone mixture used for ligamentum interspinosus and paravertebral muscles (multifidus).
Figure 4
Figure 4
Connection of the CompuFlo instrument to the epidural simulator.
Figure 5
Figure 5
Typical pressure-volume infused curve during identification of the epidural space with Compuflo: a, supraspinous ligament (first small peak); b, false loss of resistance (first dip); c, legamentum flavum (increase in resistance); and d, final identification of the epidural space (sudden drop in pressure lasting for at least 5 seconds, resulting in the formation of a low and stable pressure plateau).
Figure 6
Figure 6
Epidural simulator and human pressure curves immediately before and after the needle have entered the epidural space. (a) LOR ES simulator, (b) false LOR simulator, (c) LOR ES, and (d) false LOR. LOR ES = loss of resistance in the epidural space, False LOR = false loss of resistance (needle not in the epidural space).

References

    1. Lee R. A., van Zundert T. C., van Koesveld J. J., et al. Evaluation of the Mediseus epidural simulator. Anaesthesia and Intensive Care. 2012;40(2):311–318.
    1. Uppal V., Kearns R., McGrady E. Evaluation of M43B lumbar puncture simulator-II as a training tool for identification of the epidural space and lumbar puncture. Anaesthesia. 2011;66(6):493–496. doi: 10.1111/j.1365-2044.2011.06710.x.
    1. Pedersen T. H., Meuli J., Plazikowski E. J., et al. Loss of resistance. A randomised controlled trial assessing four low-fidelity epidural puncture simulators. European Journal of Anaesthesiology. 2017;34(9):602–608. doi: 10.1097/eja.0000000000000640.
    1. Ghelber O., Gebhard R. E., Vora S., Hagberg C. A., Szmuk P. Identification of the epidural space using pressure measurement with the compuflo injection pump—a pilot study. Regional Anesthesia and Pain Medicine. 2008;33(4):346–352. doi: 10.1097/00115550-200807000-00010.
    1. Chen E. C. S., Ameri G., Sondekoppam R. V., Ganapathy S., Peters T. Navigated simulator for spinal needle interventions. In: Westwood J. D., Westwood S. W., Fellander-Tsai L., et al., editors. Medicine Meets Virtual Reality. Amsterdam, Netherlands: IOS Press; 2014. p. p. 59.
    1. Hochman M. N., Friedman M. J., Williams W., Hochman C. Interstitial tissue pressure associated with dental injections: a clinical study. Quintessence International. 2006;37(6):469–476.
    1. Coccoluto A., Chiarenza F., Camorcia M., Capogna G. Identification of the epidural space: a double blind comparison between the CompuFlo® epidural computer controlled system and the standard LOR to saline technique in obstetrics. European Journal of Anaesthesiology. 2017;3404AP03-11
    1. Usubiaga J. E., Moya F., Usubiaga L. E. Effect of thoracic and abdominal pressure changes on the epidural space pressure. British Journal of Anaesthesia. 1967;39(8):612–618. doi: 10.1093/bja/39.8.612.
    1. Stunt J. J., Wulms P. H., Kerkhoffs G. M., Dankelman J., van Dijk C. N., Tuijthof G. J. M. How valid are commercially available medical simulators? Advances in Medical Education and Practice. 2014;5:385–395. doi: 10.2147/amep.s63435.
    1. Naemura K., Sakai A., Hayashi T., Saito H. Epidural insertion simulator of higher insertion resistance and drop rate after puncture. Proceedings of the 30th Annual International IEE EMBS Conference; August 2008; Vanvouver, BC, Canada. pp. 3249–3252.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi