Epidurals that have a local anaesthetic and narcotic (We use ropivicaine and hydromorphone): BP, P, RR, CWCM, Level of pain monitored q1/2 hr x 2hrs. Then BP, P, CWCM q2 hrs for 12 hrs, then q4h for the duration of the epidural. RR monitored every hour for 24 hrs, then q4h for the duration.
Of course, to check cwcm, you have to wake the pt up, ask them about numbness to lower extremities or circumoral numbless, etc. But after 14 hours with a stable epidural, they get more rest. And the better pain control is worth it.
Epidurals without the hydromorphone you have to worry less about the RR, but we generally follow the same protocol regardless. Low BP is our most common complication. Our anaesthesiologists are pretty good about being there to help out or at least on the phone all the time to give orders. Epidurals are a lot of work for teh nurses, but they are great for the pt's (when they work, that is!)
Do you monitor every hour for the duration of the epidural?