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British Journal of Anaesthesia, 2002, Vol. 89, No. 3 442-445
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Evaluation of S1 motor block to determine a safe, reliable test dose for epidural analgesia

Z. Daoud1, R. E. Collis*,2, B. Ateleanu2 and W. W. Mapleson2

1 Anaesthetic Department, Memorial Hospital, Darlington DL3 6HX, UK. 2 Anaesthetic Department, University Hospital of Wales and University of Wales College of Medicine, Cardiff CF14 4XW, UK *Corresponding author

Background. Accidental intrathecal injection of bupivacaine during epidural analgesia in labour remains a hazard, with the potential to cause total spinal anaesthesia and maternal collapse. Sacral block appears early after intrathecal injections compared with epidural ones, and we therefore used S1 motor block to determine a safe and reliable test dose for epidural catheter misplacement.

Methods. Mothers booked for elective Caesarean section were given various intrathecal doses of bupivacaine with fentanyl during routine combined spinal–epidural anaesthesia.

Results. Using sequential allocation we found that the ED50 for S1 motor block 10 min after intrathecal injection was bupivacaine 7 mg with fentanyl 14 µg (95% CI, 6.2–7.8 mg). We then used intrathecal bupivacaine 13 mg to look for the ED95. We found the calculated ED97.5 to be bupivacaine 9.7 mg with fentanyl 19.4 µg (95% CI, 8.7–11.4).

Conclusion. We conclude that testing for S1 motor block 10 min after epidural injection of bupivacaine 10 mg is a reliable test to detect accidental intrathecal injection in the obstetric population.

Br J Anaesth 2002; 88: 442–5


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