Epidurals and Blood pressure issues

[heaverboo]

Ive seen and also been told that epidurals with pain medications are known to drop the blood pressure? Why is this the case? Also I remember when I did my labor and delivery rotation they would give a 1000 ml bolus before anesthesia inserted the epidural. Any explanations?

[deeDawntee, RN]

Epidurals relieve pain (obviously) so any hypertension caused by pain will be reversed and the pt's BP will return to baseline. Also, there is a relaxation of muscles, even those that line the vasculature and this will cause vasodilation and a drop in blood pressure. A bolus of IV fluids will increase intravascular volume and will compensate for the dilation.

Does that make sense?

[heaverboo]

Sort of...so it just causes dilation? We use epidurals alot on orthopedics for pain relief, sometimes they work for the patient and sometimes they dont. When patients have epidurals we have standing orders if the SBP drops

[SassyJennRN]

Well I guess it depends whats running in your epi's... We use a combo of bipivucaine and fentanyl in ours. I have always been taught that it is the bipivucaine that makes the BP drop. Most of our docs have standing orders for epinephrine and fluid bolus when the systolic is below 90...and it commonly is.