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Epidural question

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Can someone help me please? If a patient has a syncopal episode while they are on an epidural why is it inappropriate to elevate their feet after they regain consciousness (i.e. putting them in a trendelenberg position)? I have found a few resources that say this is inappropriate but these articles don't say why. I am interested in understanding the patho underlying this contraindication. Thanks in advance.

BecomingNursey

Specializes in Emergency Nursing.

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.

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

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

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.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 9 years experience.

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

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

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.)