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Realistic Simulation Improves Epidural Placement Training
Clare Banigan discusses her research with classmate Eric Ramdas (DNP '25) during UB School of Nursing's 11th Annual Research Day in April 2024.
Published January 30, 2026
Epidural placement is one of the most technically challenging procedures anesthesia providers perform, relying on precise tactile perception to identify tissue layers and achieve loss of resistance (LOR) without injuring the patient. Yet, widely used training manikins can fall short in replicating the feel of human tissue, limiting a provider’s readiness before performing the procedure in practice.
A recent study published by the American Association of Nurse Anesthesiology – led by Clare Banigan, DNP ‘24, CRNA, in collaboration with University at Buffalo School of Nursing CRNA program assistant director Brian Lowe and colleagues at Highland Hospital in Rochester, New York – aims to address this gap.
The study, “Simulation Training for Epidural Placement: A Randomized Trial Comparing the Use of an Ex Vivo Porcine Spine Model with the M43B Lumbar Puncture Simulator IIA,” also Banigan’s Doctor of Nursing Practice (DNP) project, compared the effectiveness of two epidural training models: the commercially available M43B Lumbar Puncture Simulator IIA and an ex vivo porcine spine model.
Ten experienced anesthesia providers participated in an educational in-service, performing epidural placements on both models before rating them on realism, training utility and similarity to human anatomy.
The team found that porcine spine significantly outperformed the M43B manikin in nearly every measure except landmark identification, which was similar between models. The porcine model scored markedly higher for ligamentum flavum feel, LOR, catheter insertion and novice training utility, with all differences reaching statistical significance. All 10 participants preferred it, citing its lifelike tissue texture, realistic resistance and authentic procedural feel.
Proficiency in epidural anesthesia can require 60-90 clinical cases, but current residency requirements – 10 for nurse anesthesia residents and 40 for physician anesthesiology residents – fall short of this benchmark. Opportunities for repeated practice in live patients are limited, slowing skill mastery.
By offering a realistic, repeatable and ethically sourced training platform, the porcine spine model can help bridge the gap between classroom learning and clinical performance. Tissue-based models preserve the authentic mechanical properties of human anatomy, allowing learners to refine skills in a safe environment, an approach that supports patient safety and improves procedural outcomes.
Banigan’s work exemplifies the impact of practice-based research in nursing. She brought her clinical experience and expertise into the research arena, identifying a training gap and delivering findings with direct application to patient care.
Clinicians in practice are uniquely positioned to see where improvements are needed and to lead evidence-based change.
By Sarah Goldthrite
