Obstetric epidural test doses: a survey of UK practice

Horner′s syndrome and weakness of upper limb after epidural anaesthesia for caesarean section

“…We used 3 mL 0.25% bupivacaine without epinephrine as test dose by convention, and use of 3-5 mL of 0.25% bupivacaine is practiced by many specialists. [417] One survey also reported use of bupivacaine doses ranging from 3 to 20 mg.[18] However, we agree that test dose per-se has no role in evidence-based practices and every epidural dose is a test dose.…”

The extension of epidural blockade for emergency caesarean section: a survey of Scandinavian practice

“…11 The study shows that current Scandinavian practice favours lidocaine and ropivacaine as the most frequently used drugs for epidural top-ups; UK surveys report the use of bupivacaine and levobupivacaine by 61-74% of anaesthetists (only 3% in our study). 11,20 The preference for lidocaine by Scandinavian specialists may be due to the chemical properties of lidocaine, notably the lower pKa which yields a greater proportion of unionised drug at body pH that may cross the neuronal membrane resulting in faster onset of action compared to bupivacaine. Somewhat surprisingly, recommendations about choice of local anaesthetic in guidelines were very vague.…”

An observational cohort study of the meniscus test to detect intravascular epidural catheters in pregnant women

“…Because no test meets this standard, 9,10 anesthesiologists rely on a variety of different testing combinations and dosing strategies to avoid patient harm. 2,11,12 Aspiration of the catheter detects the majority, but not all, intravascular and intrathecal epidural catheters. In obstetrics, 5-8% of epidural catheters enter a vein during initial insertion, [13][14][15][16][17] and 0.04-0.14% enter the subarachnoid space.…”