The Epidural Test Dose: A Review

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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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