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Anesth Analg 2006;102:921-929
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000196687.88590.6b

REGIONAL ANESTHESIA

The Epidural Test Dose: A Review

Joanne Guay, MD, FRCPC

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.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.