The addition of 0.2 mg epinephrine to the intrathecal combination of sufentanil and bupivacaine significantly prolonged labor analgesia without causing adverse effects to the mother or fetus. The intrathecal combination of sufentanil and bupivacaine, with or without epinephrine, provided rapid, profound labor analgesia and allowed most patients to ambulate.

It has become generally accepted that a test dose should precede epidural anaesthesia to ensure that a bolus of anaesthetic solution will not be deposited either intravenously or intrathecally, l While local anaesthetics are generally used to detect intrathecal administration, considerable discussion continues with regard to a test dose that will safely, reliably, and promptly detect intravascular injection. 2-4 Various techniques have been suggested, 5-9 but, serious concerns ~~ have precluded the establishment of a "gold standard" for this test.Subjective symptoms are frequently noted in patients receiving intravenous opioids. Freeman and Hicks 15 observed such symptoms associated with the injection of fentanyl into an epidural catheter, suggesting an intravascular injection in their patient. Further testing with epinephrine produced a positive chronotropic response and prompted replacement of the catheter. These observations were confirmed by Yoshii et al. 16 However, they provided only indirect data regarding the ability of anaesthetists to predict intravascular injections. We sought to test the accuracy and reliability of the subjective symptoms associated with the administration of fentanyl. Further, we assessed the ability of anaesthetists to distinguish CAN J ANAESTH 1994 / 41:8 / pp 667-72

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