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Epidural analgesia involves injection of anesthetics into the epidural space,using a Touhy needle to proceed through the layers in the epidural region and a"loss of resistance" (LOR) syringe to sense the environment stiffness. Theanesthesiologist's case experience is one of the leading causes of accidentaldural puncture and failed epidural - the two most common complications ofepidural analgesia. Robotic simulation is an appealing solution to help trainnovices in this task. Another benefit of it is the ability to record thekinematic information throughout the procedure. In this work, we used a hapticbimanual simulator, that we designed and validated in previous work, to explorethe effect LOR probing strategies had on procedure outcomes. Our resultsindicate that most participants probed more with the LOR syringe in successfultrials, compared to unsuccessful trials. Furthermore, this result was moreprominent in the three layers preceding the epidural space. Our findings canassist in creating better instructions for training novices in the task ofepidural analgesia. We posit that instructing anesthesia residents to use theLOR syringe more extensively and educating them to do so more when they are inproximity to the epidural space can help improve skill acquisition in thistask.

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