naa a22 4500 510743900 CHVBK 20180411083038.0 cr unu---uuuuu 180411e20130401xx s 000 0 eng 10.1007/s12630-013-9887-9 doi (NATIONALLICENCE)springer-10.1007/s12630-013-9887-9 The epidural electric stimulation test does not predict local anesthetic spread or consumption in labour epidural analgesia [Elektronische Daten] [Clarita Margarido, Aleksandra Dlacic, Mrinalini Balki, Louis Furtado, Jose Carvalho] Le test de stimulation électrique péridurale ne prédit pas la diffusion ou la consommation de l'anesthésique local lors de l'analgésie péridurale pour le travail obstétrical Purpose: The epidural electrical stimulation test (EEST) is a highly specific and sensitive test for confirming placement of the epidural catheter in the epidural space. The purpose of this study was to investigate if the EEST could predict the spread and consumption of local anesthetic solutions during labour epidural analgesia. Methods: This observational study was conducted in labouring parturients requesting epidural analgesia. The EEST was performed after the epidural catheter placement (T0) and repeated five minutes after a test dose with 2% lidocaine 3mL (T1). The minimum current required to elicit the motor response at each time point was recorded. A loading dose of 0.125% bupivacaine 10mL and fentanyl 50μg was administered and followed by patient-controlled epidural analgesia with 0.0625% bupivacaine and fentanyl 2μg·mL−1 (baseline infusion 10mL·hr−1, bolus dose 5mL, lockout interval ten minutes, maximum dose 20mL·hr−1). The primary outcome was the correlation between the current required to elicit motor responses at T0 and T1 and the consumption of bupivacaine in the first two hours of epidural administration. The secondary outcomes included the muscle contraction patterns determined by the EEST and the incidence of failed, inadequate, or asymmetric blocks. Results: The study was conducted in 102 parturients. The mean electric current required to elicit muscle response was 4.43mA (range 1-10mA) at T0, 5.97mA (range 1-14mA) at T1, and the mean Δ (T1-T0) current was 1.54mA (range 0-8mA). There was no correlation between either the mean baseline current required or the Δ (T1-T0) current and the total bupivacaine consumption at two hours. The incidence of inadequate blocks at two hours was 18%; however, none of the catheters required replacement. Unilateral left (34%) or right (31%) leg contraction was the most frequent pattern elicited by the EEST. Conclusions: The EEST shows a wide range of electrical current requirements and elicits a variety of muscle twitch patterns on the lower limbs. Although it confirms the epidural placement of the catheter, the EEST cannot be used to predict the spread or consumption of the local anesthetic solution during labour epidural analgesia. Canadian Anesthesiologists' Society, 2013 Margarido Clarita Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Dlacic Aleksandra Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Balki Mrinalini Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Furtado Louis Queen's University, Kingston, ON, Canada aut Carvalho Jose Departments of Anesthesia and Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/4(2013-04-01), 393-398 0832-610X 60:4<393 2013 60 12630 https://doi.org/10.1007/s12630-013-9887-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9887-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Margarido Clarita Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Dlacic Aleksandra Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Balki Mrinalini Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Furtado Louis Queen's University, Kingston, ON, Canada aut NATIONALLICENCE 700 1- Carvalho Jose Departments of Anesthesia and Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/4(2013-04-01), 393-398 0832-610X 60:4<393 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer