Wide range of epidural rates for use with PCEA

1. I've noticed that depending on the anesthesiologist, our patients will have this wide range of different epidural rates for use with a PCEA.
   
   For instance, the continuous hourly rate I have seen anywhere from 8-15 cc/hr.
   
   Bolus rates of 4-10cc, with lockout ranges from 10-60 minutes.
   
   Usually though, the total hourly lockout will be no more than 25-26cc/hr.
   
   It was my understanding, when we started with PCEA epidurals, that the basal rate would be low - in the 6-8cc/hr range, and the bolus would be small but frequent (2-4cc every 10-15 minutes).
   
   Just the other day, I had a PCEA with the following dosages: 15cc basal, 5cc bolus Q 30 minutes, total hourly maximum was 25 cc/hr. Me thinks the doc didn't want called back for redoses for breakthrough pain! That was by far the highest basal rate I had ever seen.
   
   Thoughts?
2. 

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   Joined: Dec '02; Posts: 282; Likes: 79
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   Specialty: 10 year(s) of experience in L&D

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3. 
   Dec 12, '07

   Occupation: L&D RN Specialty: 10 year(s) of experience in L&D ; Joined: Dec '02; Posts: 282; Likes: 79

   I forgot to mention, our epidural bags are all a mixture of 2 mcg fentanyl per cc in 0.125% bupivicaine. Total bag volume is 100 cc.
4. 
   Dec 13, '07

   Occupation: LDRP Joined: May '05; Posts: 239; Likes: 58

   That doesn't seem too outrageous. Our basal rates are 10-15cc with a 5cc blous dose and a 20 minute lockout for a total of up to 30cc hourly. If that still does not keep them comfortable they are allowed to get top ups.
5. 
   Dec 14, '07

   Joined: Jan '07; Posts: 48; Likes: 19

   We use 14-16 ml/hr as a basal rate. Our PCEA doses are 4-5 ml boluses every 20-30 minutes depending on the doc.
   
   So 8 ml/hr seems pretty low to me!!! How do the patients do with that???
   I have never had to call a doc back with the dosages we use.

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