Epidural question

BecomingNursey · Jun 18, 2015

I would think it would be because the anesthesia from the epidural could affect their respiratory status if the patient was put in trendelenburg. Im not an L&D nurse though so maybe one of the L&D nurses could better answer your question.

Simonesays, BSN, RN · Jun 18, 2015

Thanks for your reply! I should clarify that this is an epidural infusion and a post-op patient (not L&D).

MunoRN, RN · Jun 18, 2015

Positioning can alter an epidural's effect and dermatome level, although usually pretty minimally, but more importantly it's no longer recommended to put a patient in trendelenburg due to hypotension or syncope, if anything that does more harm than good.

Simonesays, BSN, RN · Jun 18, 2015

Thanks Muno! Can you expand? Do you have any good links?

mmc51264, BSN, MSN, RN · Jun 18, 2015

We use epidurals for some of our hip replacement pts (or other major hip sx) and what we have been told is that we don't want the medication heading north, When our pts get dizzy or hypotensive, we usually sit them down (it usually presents when they get up for the first time). We have a pain team that deals with the regionals and epidurals

Simonesays, BSN, RN · Jun 19, 2015

Thanks for your replies!

SierraBravo · Jun 19, 2015

One of the reasons is that blood from the brain returning to the heart via the SVC returns by gravity. If you put someone in trendelenburg position then it minimizes the blood return to the heart, which obviously exacerbates the SNS response and compensatory mechanisms.

Canadian Journal of Emergency Medicine - Myth: The Trendelenburg position improves circulation in cases of shock - Cambridge Journals Online

Here.I.Stand, BSN, RN · Jun 19, 2015

What they said. ^^^ Typically, if one of our pts gets hypotensive, they get a fluid bolus. And we reduce the drip rate if their pain stays controlled. (Our anesthesiologists give a dose range, usually Ropivicaine at 1-12 ml/hr.)