A survey on labor epidural test dose practices in India.

Abstract

There is a lack of consensus and uniformity about the test dose in epidurals for labor analgesia. We, therefore, conducted a questionnaire-based survey to assess the current practice in India regarding test-dose for labor epidurals among practicing obstetric anesthetists. A Google form based questionnaire was circulated to 300 members of the Association of Obstetric Anesthesiologists (AOA) of India of which 128 (42.7%) responded. According to our survey, labor analgesia is routinely practiced by only 40 (32%) responders. Sixty-eight (53.1%) responders reported placement of an epidural catheter at the patient's request. Less than 50% reported the use of test dose for epidural catheter placement confirmation. Ninety-eight (76.6%) responders give the test dose at the time of catheter placement while 22 (17.1%) give it every time before injecting the local anesthetic as a top-up. The majority preferred using 3-4 mL of 2% lidocaine as test dose. Seventy-three (57%) responders relied on the use of conventional test dose of lidocaine with epinephrine. 8.5% of responders had experienced side effects with epidural test dose during labor analgesia. This survey highlights not just variations in the clinical practice regarding epidural test dose for labor analgesia but gross deviation from the current recommended standard of practice. The issue can be addressed by developing clear practice guidelines.