Royal Alexandra Hospital Department of Anaesthetics
  • Home
  • Meet our staff
    • Permanent staff
    • Junior staff
  • Rotas
    • Big rota 31 Aug-6 Sept 2020
    • Big rota 24-30 August 2020
    • Big rota 17-22 August 2020
    • Big rota 10-16 August
    • Big rota 3-9 August
    • Big rota 20 - 26 July
    • Big rota 13 - 19 July
    • Big rota 29 June - 5 July
    • Old rotas >
      • Big rota 22-28 June
      • Big rota 15 - 21 June 2020
      • Big rota 8 - 14 June 2020
      • Big rota 1 - 7 June 2020
      • Big rota 25 May-31 May
      • Big rota 18 - 24 May
      • Big rota 11-17 May
      • ICU 20 Apr- 17 May rota
      • Big rota 4-10 May
      • Big rota 27 Apr-3 May
      • Maternity 23 Mar-3 May rota
      • All 20-26 April (rota)
      • COVID 19 >
        • PPE (COVID 19) >
          • Droplets and aerosols (COVID 19)
          • PPE-What to wear and when (HPS/PHE)
          • FFP3 or surgical mask?
          • Donning and doffing PPE (COVID 19)
        • Thromboprophylaxis (COVID 19)
        • Staff support (COVID 19)
        • Human factors in a crisis
        • Obstetrics >
          • PPE in obstetrics (COVID 19)
          • Avoiding category 1 caesarean section (suspected COVID 19)
        • Critical care/ICU >
          • ICM West of Scotland Trainee Website
          • Thromboprophylaxis critical care (ICU)COVID 19
          • ICM / ICU website
          • Death Certificate (COVID 19)
          • Phillips Trilogy 2 ventilator setup (COVID 19)
          • Phillips Trilogy ventilator info (COVID 19)
          • ICU room checklist (COVID 19)
        • Theatres >
          • Intercollegiate General surgery guidance (PPE/AGP/COVID 19)
          • Fragility fractures patient management (COVID 19)
          • Theatre brief checklist (COVID 19)
          • Theatre personnel PPE advice (COVID 19)
          • Theatre equipment checklist (COVID 19)
          • Anaesthesia SOP (COVID 19)
        • Trakcare alerts guide
        • COVID FAQs March 2020
  • Induction
    • New Start Resources >
      • Before you start
      • RCoA Novice Guide
      • Anaesthetic machine instruction
      • Tutorials for new starts
      • Structured training for novices (STAN)
    • General
    • Obstetrics
    • ICU
  • Education
    • General Tutorials
    • ICU Tutorials >
      • Renal videos
    • FRCA Resources >
      • Primary
      • Final
    • RCoA Anaesthetists As Educators
  • Guidelines
    • Antibiotics >
      • Gentamicin prescribing (antibiotics)
      • Gentamicin surgical prophylaxis (antibiotics)
    • Quick reference handbook (QRH)
    • Anaphylaxis >
      • Anaphylaxis service referral
      • Anaphylaxis blood tests
    • Colorectal surgery >
      • ERAS (Enhanced recovery after surgery)
    • Dental referrals
    • Gynaecology >
      • Analgesia for hysterectomy (open)
    • ICM (ICU)
    • Obstetrics >
      • Maternity handbook
      • Gentamicin (obstetric prophylaxis)
      • Epidurals >
        • Epidural pump setup
        • Epidural top ups
        • PCEA info
      • Thromboembolic disease in pregnancy
      • Eclampsia
      • Preeclampsia
      • Post dural puncture headache
      • Tranexamic acid in PPH (obstetrics)
      • Post partum haemorrhage (PPH)
      • Antibiotics for caesarean section/assisted delivery (obstetrics)
      • Caesarean section analgesia (obstetrics)
      • Syntocinon for caesarean section (oxytocin)
      • Remifentanil PCA (obstetrics)
    • Orthopaedics >
      • Tranexamic acid for hip and knee replacement
      • Analgesia for hip and knee replacement
  • Useful stuff
    • Phone numbers >
      • All phone numbers
      • Maternity unit phone numbers
  • Contact us
  • Pumps (Baxter/Alaris)
    • Baxter volumetric pump
  • Trauma July-Oct 2020
Epidural top up options for caesarean section

Option 1 (rapid onset): 2% lidocaine + adrenaline 10µg + fentanyl 5µg/ml

  • 2% lidocaine with adrenaline plus fentanyl gives the quickest time to surgical anaesthesia. This option can be used for category 1 sections in patients with a functioning epidural
  • There are ampoules of 20ml 2% lidocaine in the epidural trolley and in theatre A.
  • Draw up one amp of 20ml 2% lidocaine
  • Add 0.1ml of 1:1000 adrenaline (one of the small ampoules)
  • Add 2ml fentanyl to the syringe.
  • Give 10-15ml of this solution, depending on the existing block height.
  • Stay with the patient on transfer to theatre.
  • Check the block height and motor block once on the table.
  • Give the remaining 5-10ml if the block height is still suboptimal.

Option 2 (duration): 0.5% levobupivacaine + fentanyl 5µg/ml
For quality of block, both lidocaine and ropivacaine are superior to (levo)bupivacaine. However, our hospital does not stock ropivacaine, and lidocaine may not last long enough for a complicated section. So for category 2 or 3 caesarean sections with a functioning epidural:
  • draw up 20ml 0.5% levobupivacaine
  • add 2ml (100 micrograms) of fentanyl
  • give 10-15ml depending on existing block height, and check the block after 10-15 minutes.