Epidural top up options for caesarean section
Option 1 (rapid onset): 2% lidocaine + adrenaline 10µg + fentanyl 5µg/ml
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:
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.