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Epidural test dose in obstetric patients

should we still use it?

Massoth, Christina; Wenk, Manuel

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 263–267
doi: 10.1097/ACO.0000000000000721
OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Emilia Guasch and Manuel Wenk
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Purpose of review As the application of a test dose after epidural catheter insertion in obstetrics has recurrently been associated with serious adverse events affecting both maternal and foetal outcomes, the question whether to test or not remains a controversial issue.

Recent findings Present guidelines do not provide clear recommendations in this regard and several recent surveys indicate a heterogeneity in clinical routine.

Summary Physiological alterations during pregnancy and labour restrict the use and also the validity of traditional test agents. Epinephrine is not appropriate to detect a vascular insertion in labour and the application of a local anaesthetic test dose may lead to dose-dependent fatal consequences should the catheter be intrathecal, due to an increased sensitivity in parturients. Given the current practice of opioid-amended–low-concentration epidurals, the waiving of a test dose results at worst in a failed epidural, a stark contrast to the potentially severe to fatal complications of a ‘traditional’ test dose. Hence, an originally preventive measure providing potentially more harm than the consequences of the situation aimed to prevent, should not be recommended. A simple fractionated administration of the initial analgesic dose seems reasonable though.

Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany

Correspondence to Dr Manuel Wenk, Professor, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany. Tel: +49 251 8347255; e-mail: manuelwenk@uni-muenster.de

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