BACKGROUND: This study prospectively evaluated the ability of @entity1173 to detect intravascular placement of multiple-orifice epidural catheters. METHODS: Multiple-orifice, 20-gauge epidural catheters were inserted in 1,029 laboring @entity1 . Catheters were observed and aspirated for blood or cerebrospinal fluid before they were tested with 2 ml local anesthetic. If the results of this test were negative (no spinal anesthesia), the authors induced and maintained labor @entity1337 with a dilute local anesthetic and opioid solution. @entity1 with bilateral sensory change and effective labor @entity1337 had a "positive" epidural catheter. @entity1 with unilateral block, inadequate @entity1337 despite some sensory change or those who delivered before being adequately assessed had "equivocal" catheters. @entity1 with neither @entity1337 nor sensory change had "negative" catheters. RESULTS: Aspiration and observation identified 60 intravenously placed catheters. Six catheters, which were placed initially in a blood vessel, were withdrawn until @entity1173 was negative, and then the anesthetic was infused. Four of these catheters were positive and two were still positioned intravascularly. Two other catheters may have been intravenously placed despite negative results of @entity1173 . The incidence of false-negative results of @entity1173 was 0 to 2 of 1,085 (upper limit of 95% CI, 0.2% to 0.4%). No @entity1 showed any signs or symptoms of @entity137 . CONCLUSIONS: Under the conditions of this study, which include using multiple-orifice catheters and dilute solutions of local anesthetic and opioid, @entity1173 and incremental drug injection alone safeguard against the risks of intravenously positioned local anesthetics. These results should not be extrapolated to other clinical settings without further study.

Labor epidural XXXX without an intravascular "test dose".

@entity1 :: ('9606', 'Species') :: ['women', 'Patients', 'Women', 'patient'] @entity1337 :: ('MESH:D000699', 'Disease') :: ['analgesia'] @entity137 :: ('MESH:D064420', 'Disease') :: ['local anesthetic toxicity'] @entity1173 :: ('MESH:D053120', 'Disease') :: ['aspiration']
@entity1337 :: (MESH:D000699,Disease) :: ['analgesia']
