title: The effect of epidural test dose on motor function after a combined spinal-epidural technique for labor analgesia.
abstract: Labor analgesia initiated with intrathecal bupivacaine and fentanyl, without a local anesthetic epidural test dose, provides effective analgesia and allows ambulation. In this study, we sought to determine the effect of a lidocaine-epinephrine test dose administered immediately after the initiation of combined spinal-epidural (CSE) analgesia with bupivacaine 2.5 mg and fentanyl 25 micro g on parturients' hemodynamic stability, posterior column function, motor strength, and subjective ability to walk. Parturients (n = 153) were randomized to receive either 3 mL of epidural saline or lidocaine 1.5% with epinephrine 1:200,000. Hemodynamic variables, proprioception, straight leg raise, and the modified Bromage score were analyzed in 110 parturients who completed the study protocol and were not different between groups. Vibratory sense, the ability to perform a partial deep knee bend and to step up on a stool, and the subjective ability to walk were impaired in a larger number of parturients in the lidocaine-epinephrine group at 30 min (P < 0.05). At 60 min, there were no differences between the groups except that fewer parturients in the lidocaine-epinephrine group could step up on a stool. The straight leg raise against resistance and the modified Bromage scale did not correlate well with other tests of motor strength (Spearman's rho, 0.273-0.405). These data suggest that the test dose should be avoided immediately after initiation of CSE analgesia when early ambulation is desired.
  
  
  CONCLUSIONS
  A lidocaine-epinephrine epidural test dose (3 mL of lidocaine 1.5% with epinephrine 1:200,000), injected immediately after the initiation of combined spinal-epidural labor analgesia with bupivacaine 2.5 mg and fentanyl 25 microg, may interfere with the ability to perform simple tests of motor function and ambulation.
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Calimaran
authors.forename: Tina P
authors.initials: TP
authors.lastname: Strauss-Hoder
authors.forename: Warren Y
authors.initials: WY
authors.lastname: Wang
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Wong
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D009046:Motor Neurons / Q000187:drug effects; D009407:Nerve Block; D011247:Pregnancy; D011434:Proprioception / Q000187:drug effects; D012677:Sensation / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014732:Vibration; D016138:Walking
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine