Teaching Loss of Resistance to Trainees: A Stepwise Expert-Consensus Approach to Developing Tactile Competence in Epidural Procedures

Loss of resistance (LOR) remains one of the most commonly used methods for identifying the epidural space, yet it can be challenging to teach because the endpoint is primarily tactile. Written descriptions and procedural demonstrations can explain the concept but cannot fully communicate the sensation of resistance followed by its characteristic reduction. Furthermore, allowing an inexperienced trainee to simultaneously advance the epidural needle and interpret an unfamiliar tactile endpoint may unnecessarily combine two distinct learning tasks. We believe that asking trainees to acquire both skills simultaneously during a procedure on a real patient is suboptimal, particularly given the potential clinical consequences of incorrect needle advancement or misinterpretation of the loss-of-resistance endpoint. In this expert educational perspective, we describe a progressive approach used by the authors to teach LOR. Trainees first receive focused education regarding epidural anatomy and the LOR concept, followed by observation of procedures performed by experienced physicians. The trainee is then introduced to a transitional stage in which the supervising physician retains complete control of needle advancement while the trainee operates the LOR syringe and concentrates solely on identifying the tactile endpoint. Once the trainee repeatedly demonstrates recognition of LOR, responsibility for needle advancement is progressively transferred under direct supervision. This staged approach separates tactile learning from needle manipulation and may provide a practical framework for teaching epidural access while maintaining patient safety.