Epidural test doses

Abstract

I read with interest the letter from Drs. Hodgkinson and Husain (1) in which they suggest that the routine injection of a test dose of local anesthetic solution through a needle in the epidural space be abandoned during induction of epidural anesthesia. The practice in Brazil supports their suggestion. Although a good number of epidural anesthetics are administered here, I know of no anesthesiologist who uses or advises test doses routinely in his daily practice. In 1977 a study dealing with 13,872 epidural anesthetics for various surgical procedures was presented at the Brazilian Congress of Anesthesiology (a society with a membership of more than 4000 physicians). Major findings included the absence of neurologic sequelae, a 1/2000 incidence of total spinal anesthesia, and a l/4000 incidence of convulsions. These results compare well with statistics that have been published in the world literature From departments in which the test dose is a must in every epidural anesthetic. In my opinion test doses routinely injected through epidural needles are a waste of time. 1 believe test doses should be reserved for those occasions when the anesthesiologist has doubt about the possibility of either dural puncture or vascular injection.