Wider Scope
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| 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
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| 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
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| 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
- NO CTG MONITORING
- 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
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| 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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| Other | |