ELECTROCARDIOGRAPHIC AND HEMODYNAMIC-CHANGES ASSOCIATED WITH UNINTENTIONAL INTRAVASCULAR INJECTION OF BUPIVACAINE WITH EPINEPHRINE IN INFANTS

SINGLE-DOSE caudal administration of bupivacaine has been accepted widely as a means of providing perioperative analgesia for lower limb, anoperineal, and lower abdominal procedures in children.1,2 Unintentional intravascular injection of local anesthetic during caudal block placement may cause life-threatening central nervous system and cardiac sequelae. A test dose of 10-15 mug epinephrine has been advocated as a reliable indicator of intravascular injection in adults,3,4 but epinephrine has not been proved reliable as an indicator of intravascular injection in anesthetized infants and children.5 In conscious infants having a caudal anesthetic, the reliability of epinephrine as an indicator of intravascular injection has not been studied. We report five cases in which ST-T-wave changes and relative bradycardia during administration of a test dose alerted us to intravascular injection during caudal administration of bupivacaine with epinephrine.