Code Blue after Thoracic Epidural Placement, is it time to rethink our test dose?

 

Thoracic and lumbar epidurals are pivotal in managing perioperative pain, particularly in patients with significant traumatic injuries and those undergoing major surgeries (1). Thoracic epidurals are often preferred for surgeries involving the thorax and upper abdomen, as they provide superior pain control in these regions by targeting the sympathetic nerve fibers. The administration of thoracic epidurals requires precise dosing to avoid severe complications due to systemic absorption or misplacement, such as cardiovascular instability, which are less commonly seen with lumbar epidurals. This case report highlights a patient who underwent the administration of a 5ml bolus through a thoracic epidural after a negative test dose, who quickly experienced hemodynamic instability.