Regional Analgesia

Selected Guidelines Examples                                                                                                                                     
Frimley Health Hospital NHS TRUST Nov 2018
North Bristol Hospital NHS Trust Sept 2017
West Suffolk Sept 2017

Wider Scope
General Points
  •  Use of Regional Analgesia in Labour and identification and management of its complications
  • Previous epidural blood patch – spread of LA may be affected and the same risk of ADP exists but successful epidural analgesia following EBP is common
We Liked
  • Mention of temperature increase with epidural analgesia
  • Clearly defined role of the anaesthetist (P 5): keep wait short, ask for help if unsuccessful, check regularly.
  • Paragraph on inadequate analgesia and ‘mass of drug’ vs. concentration / volume
  • Table on trouble shooting (10.1) is very good.
  • Table of potential problems also very good (10.2)
  • Best practice points useful.
  • I presume these need to be anonymised apart from they are from and ratifications - I've done what I can with the Word docs but the pdfs I'm not sure what to do with them!
  • Monitoring Compliance
  • Comprehensive and thoughtful
  • Graphic decision tree
  • Overall content good but the order could be more logical
  • All women must be given the Information on spinals and epidurals leaflet prior to discharge, even if regional analgesia was only attempted
  • Perform aspiration test, siphon and meniscus (Shaw) tests

We Didn't Like
  • Demyelenation / MS - Not known if epidurals are neurotoxic in this condition. Only proceed if patient accepts this unquantified risk.
  • Pain which breaks through as labour progresses is about the potency or opiate content of the local anaesthetic agent – not sure this is true
  • 5 ml 2% Lidocaine with 1:200,000 Adrenaline, with patient sitting up. Don’t think should be used in labour
  • Infuse 250 - 500mls Compound Sodium Lactate stat and reassess. Consider further 500mls bolus Compound Sodium Lactate
  • Commence 1000mls Hartmann’s over 6 hours – a preload is not required for low dose epidurals
  • The woman will need to have an intravenous cannula inserted and will require IV fluids through the vein
  • Not a very specific protocol.
  • For CSE I think epidural should be tested by the anaesthetist once spinal starts to ware off. Start the epidural infusion immediately at rate of 10-15mls/hr. This needs to be checked by a midwife and signed on the printed out notes.
  • Neurological disease, e.g multiple sclerosis contraindication
  • IUD under contraindication
  • CSE infusion – not sure about connecting an infusion to an untested epidural catheter

Not Sure about
  •  The most recent FBC should be reviewed – this is mandatory for patients with hypertensive disease. Not specific enough
  • Continuous infusion running at 10ml/hr (range 8-15ml/hr) o Patient-controlled bolus dose 5ml o Lockout period 20 minutes.
  • If the neurological deficit persists for more than 24 hours, the woman must be referred to a Neurologist. Unrealistic


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