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REGIONAL ANESTHESIA

The Epidural Test Dose: A Review

Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Canada

Address correspondence and reprint requests to Dr. Joanne Guay, MD, FRCPC, Clinical Associate Professor, Anesthesia, Maisonneuve-Rosemont Hospital, 5415 L'Assomption Boulevard, Montreal, Quebec, Canada H1T 2M4. Address e-mail to joanne.guay{at}umontreal.ca.

This review systematically examines the literature on the ability of the classical epidural test dose and other strategies to detect intravascular, intrathecal, or subdural epidural needle/catheter misplacement. For detection of simulated intravascular misplacements, a sensitivity (S) and a positive predictive value (PPV) 80 demonstrated by at least two randomized controlled trials coming from two different centers were determined for the following tests and patient populations: Nonpregnant adult patients = increase in systolic blood pressure (SBP) 15 mm Hg (S = 80–100 and 93–100; PPV = 80–100 and 83–100) or either an increase in SBP 15 mm Hg or an increase in heart rate 10 bpm after the injection of 10 (S = 100; PPV = 83–100) or 15 µg of epinephrine (S = 100; PPV = 83–100); pregnant patients = sedation, drowsiness, or dizziness within 5 min after the injection of 100 µg of fentanyl (S = 92–100; PPV = 91–95); and children = increase in SBP 15 mm Hg after the injection of 0.5 µg/kg of epinephrine (S = 81–100; PPV = 100). Conversely, more studies are required to determine the best strategies to detect intrathecal and subdural epidural needle/catheter misplacements in these three patient populations.

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