Purpose of review: This review examines the literature on the ability of an epidural test dose to detect intravascular or intrathecal epidural catheter misplacement in the obstetric patient.
Recent findings: There is no consensus on the exact nature of the epidural test dose in obstetrics, as no single regimen has been proven to be completely effective as an epidural test dose. The administration of a test dose is especially important in patients who may require the administration of a large dose of local anesthetic such as for an emergency cesarean section. However, the accidental administration of an intended epidural therapeutic dose during labor analgesia, in either the intravascular or the intrathecal space, is not completely safe.
Summary: Gentle aspiration followed by an appropriate test dose, in epidural anesthesia for cesarean section, and careful observation of the patients in epidural labor analgesia increase the likelihood that an incorrectly placed catheter will be detected and that a harmful reaction to local anesthetics will be avoided.