EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT EPIDURALS

Epidural anesthesia entails threading a catheter into the epidural space to administer local anesthetics. The epidural space is located between the dura mater and the vertebrae and is a passageway for nerve roots leaving the spinal cord. The nerves are bathed in the anesthetic, thus providing pain relief for the areas of the body they innervate.

Before you start:

  • Physician order
  • Patent IV, 500-1,000 ml fluid bolus at start of epidural
  • Patient consent, patient teaching done
  • Safety pause
  • Knowledge of baseline vital signs
  • Knowledge of fetal status per EFM

Initiation of epidural- nursing responsibilities

  • Position patient on her side or sitting. Support the mother throughout procedure. Continue fetal monitoring throughout procedure.
  • Place blood pressure cuff on patient arm and pulse oximeter on finger.
  • Safety pause
  • Note maternal blood pressure and pulse rate before and after the test dose.

Ongoing assessment

  • Monitor BP, pulse rate every 5 minutes throughout administration of anesthetic dose and then regularly per institution protocol
  • Continuous fetal monitoring
  • Evaluate level of anesthesia.
  • Avoid maternal hypotension with uterine displacement, preferably by turning patient to left or right lying positions. Change maternal position every 30-60 minutes
  • Evaluate level of pain relief using pain scale.
  • Evaluate bladder status and empty with straight or Foley catheter as needed.

Complications

Hypotension- generally seen 10-20 minutes after injection. A systolic BP less than 100mm/HG or 20% decrease from preanesthesia levels.

  • Turn patient to side.
  • Give IV fluid bolus.
  • Start O2 at 10 liters/min via non-rebreather mask
  • Notify anesthesia
  • If vasopressors are needed, give 5-10 mg Ephedrine IV as ordered.
  • Observe for signs of fetal distress.

High spinal-profound motor and sensory block within 1-5 minutes of epidural injection.

  • Call anesthesiologist and additional nursing personnel.
  • Have suction, ambu bag and crash cart available.
  • Support blood pressure with fluids and vasopressors.
  • Observe for signs of fetal distress.

Intravascular injection of local anesthetic- signs include change in maternal heart rate, maternal hypertension, dizziness, tinnitus, metallic taste, loss of consciousness

  • Call for help, anesthesiologist.
  • Obtain crash cart.
  • Monitor fetal heart rate, blood pressure, EKG
  • If convulsion occurs, support patient with resuscitative measures as necessary- CPR, incubation, medications.