From the *Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †Department of Radiology, Division of Vascular & Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and ‡Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.
Reg Anesth Pain Med. 2017 Jul/Aug;42(4):469-474. doi: 10.1097/AAP.0000000000000580.
Thoracic epidural anesthesia is a technically challenging procedure with a high failure rate of 24% to 32% nationwide. Residents in anesthesiology have limited opportunities to practice this technique adequately, and there are no training tools available for this purpose. Our objective was to build a low-cost patient-specific thoracic epidural training model.
We obtained thoracic computed tomography scan data from patients with normal and kyphotic spine. The thoracic spine was segmented from the scan, and a 3-dimensional model of the spine was generated and printed. It was then placed in a customized wooden box and filled with different types of silicone to mimic human tissues. Attending physicians in our institution then tested the final model. They were asked to fill out a brief questionnaire after the identification of the landmarks and epidural space using ultrasound and real-time performance for a thoracic epidural on the model (Supplemental Digital Content 1, http://links.lww.com/AAP/A197). Likert scoring system was used for scoring.
The time to develop this simulator model took less than 4 days, and the materials cost approximately $400. Fourteen physicians tested the model for determining the realistic sensation while palpating the spinous process, needle entry through the silicone, the "pop" sensation and ultrasound fidelity of the model. Whereas the tactile fidelity scores were "neutral" (3.08, 3.06, and 3.0, respectively), the ultrasound guidance and overall suitability for residents were highly rated as being the most realistic (4.85 and 4.0, respectively).
It is possible to develop homemade, low-cost, patient-specific, and high-fidelity ultrasound guidance simulators for resident training in thoracic epidurals using 3-dimensional printing technology.
胸椎硬膜外麻醉是一项技术要求较高的操作，全国范围内的失败率高达 24%至 32%。麻醉学住院医师实践该技术的机会有限，且目前尚无专门用于培训的工具。我们的目标是开发一种低成本、个体化、高仿真的胸椎硬膜外麻醉培训模型。
我们从患有正常和脊柱后凸的患者中获取胸部计算机断层扫描数据。从扫描中分割出胸椎，生成并打印出脊柱的三维模型。然后将其放置在定制的木盒中，并填充不同类型的硅胶以模拟人体组织。我院主治医生对最终模型进行了测试。他们在使用超声识别标志和硬膜外腔后，以及在模型上进行实时胸椎硬膜外操作后，填写了一份简短的调查问卷（补充数字内容 1，http://links.lww.com/AAP/A197）。采用李克特评分系统进行评分。
开发该模拟器模型的时间不到 4 天，材料成本约为 400 美元。14 名医生测试了该模型，以确定在触诊棘突、硅胶中进针、“弹响”感和模型超声保真度时的真实感觉。虽然触觉逼真度评分为“中性”（分别为 3.08、3.06 和 3.0），但超声引导和对住院医师的整体适用性评分很高，被认为最逼真（分别为 4.85 和 4.0）。
使用三维打印技术，开发一种用于住院医师胸椎硬膜外麻醉培训的自制、低成本、个体化、高仿真超声引导模拟器是可行的。
