This kind of relates to my previous post re: fentanyl in epidural affecting breastfeeding, but also b/c one of our MD's the other day commented that "the epidurals here suck"...

so, just curious

- what kind of epidurals do you use on your unit?

-is there a standard drug mix or do different anesthetists do it their own way?

and whatever else you have to say :)

The epidural drip contains a standard dose of bupivicaine, mixed by pharmacy, dated and kept in our fridge for use. The majority of our MDAs do add fentanyl to this drip after the initial loading dose of bupivicaine to get things started. I think they work well for the most part. The patients feel good, and can often independently move their legs and bottoms well. They also push very effectively almost all the time, feeling a lot of pressure but no pain whatsoever.

And breastfeeding usually goes very well, as long as mom and baby are willing. Most of the time, the babes are very receptive and alert that first hour after birth, so we try very hard to get breastfeeding established ASAP following birth.

Does this help?

WE have 3 varieties of premixed epidural cassettes. 1. Fentanyl/Bupivicaine mix. 2. Sufenta/Bupivicaine mix. 3. Bupivicaine only. each one is premixed, each anesthesiologist (large group) has their preference (we have a list) so we know).

they do set the CADD pumps up for the continuous dose/demand dose on their own, so i'm sure that some do give higher doses/rates. Some also give an amp of Fentanyl in IV before starting epidural to help pt relax.

ps-the fentanyl/bupivicaine mix is by far the most popular one, followed by sufenta/bupivicaine.

We were using ropivacaine alone (Naropin) and now the new mix is ropivacaine (Naropin) with fentanyl for everyone.

Each anesthetist may do their bolus differently... not usually exactly sure what they're doing over there (we set up our infusion pumps so I know about that part). Ropivacaine (Naropin) has less motor side effects and less instrumental deliveries over bupivacaine according to their website - anyone else using it?

I'm just always curious what other places are doing.

We use Fentaynl/Bupivicaine mix with a loading dose of the Fentanyl. I have never noticed any difference in breastfeeding between those who did and didn't have epidurals or primips vs multips although multips who breastfed previously obviously did better overall, but not always. It depends on both mom and baby. Some babies are just poor latchers or poor suckers regardless of the anesthesia or experience of the mom.