The epidural test dose in obstetric anesthesia: it is not obsolete.
Many anesthesiologists have called for the abandonment of the epidural test dose in the obstetric patient, citing its lack of sensitivity and specificity. A test dose of lidocaine 1.5% with epinephrine 1:200,000, in combination with aspiration, is highly effective in detecting incorrect placement of an epidural catheter. If the catheter is intrathecal, it requires approximately 2 minutes to obtain a sensory level. For the detection of an intravascular catheter, a positive test dose would result in a sudden increase in the maternal heart rate of 10 beats per minute within 1 minute after injection. It should not be administered during uterine contraction, as labor pain may trigger a tachycardic response. This test dose has been extensively studied and is safe both for both mother and fetus.
Gaiser
Robert R
RR
Department of Anesthesiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. gaiserr@mail.med.upenn.edu
D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002404:Catheterization / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008012:Lidocaine / Q000008:administration & dosage; D011247:Pregnancy; D012680:Sensitivity and Specificity
D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine