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To the Editor: Regarding the Clinical Crossroads article by Dr Sachs,¹ we would like clarification of the medication for the test dose for the epidural anesthesia that was used for labor analgesia. While indicated as 3 mL of 1% to 5% lidocaine, this is an unfamiliar description. A common test dose is 45 to 60 mg of lidocaine (equivalent to 3 mL of 1.5% or 2% lidocaine) with 1:200 000 epinephrine dilution. The rationale for a test dose is to detect an inadvertent intrathecal or intravenous placement of the epidural catheter. The abrupt drop in blood pressure (174/104 mm Hg to 53/33 mm Hg) is not the expected response with an appropriately placed epidural tip and is suggestive of a possible intrathecal catheter location. It is unclear whether this was excluded prior to initiating epidural analgesia.

Dr Sachs describes a temporal relationship between the placement of the epidural test dose and . . . [Full Text of this Article]

Mandy Sander-Prather, MD
msander@kumc.edu

Martin De Ruyter, MD
Department of Anesthesiology
Kansas University Medical Center
Kansas City

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