Bedside test for diagnosis of oedema fluid after extradural anaesthesia

Abstract

Purpose : To consider and differentiate oedema fluid from other fluids in the performance of epidural block. Clinical features; A patient underwent placement of an epidural catheter for vaginal delivery of twins. Following a loss of resistance technique using air a small amount of fluid was aspirated through the needle and subsequently through the epidural catheter. The epidural block and delivery followed uneventfully. After delivery oedema fluid oozed from the puncture site for a number of days. Laboratory investigation revealed that this fluid was of oedematous origin. Bedside determination of alkaline pH by ComburlO Test M urine stick appeared to be a simple and useful test for distinguishing the oedema fluid from fluids of other possible sources. Conclusion: When performing an epidural blockade the retum of fluid may be due to oedematous fluid. Differentiation of the pH by a simple bedside test can aid in the differential diagnosis and prevent unnecessary additional attempts at needle repositioning.

Identification of the Epidural Space: Loss of Resistance with Air, Lidocaine, or the Combination of Air and Lidocaine

“…Leaking of edema fluid may also occur (23). Addressing this issue, Russell (2) suggested that it is better to use a technique that reduces the incidence of complications rather than one that facilitates their diagnosis.…”

Cutaneous fluid leakage after epidural catheter removal

“…A simple bedside test to differentiate edema fluid from CSF is to determine the pH of the fluid. A more alkaline pH is in favor of edema fluid[ 2 3 ] [ Table 1 ]. The diagnosis of CSF can be made by testing the fluid for CSF specific acetyl cholinesterase by protein electrophoresis.…”