Update: Epidurals and c-sec

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

Hello All! It's time for me to re-visit my practice (habit) of my doses and drugs of choice for laboring epidurals when a c-sec has been called.

Currently I use 5-10 mL of 2% lidocaine (with or without epi) with 5-10 mL of nesacaine to speed it up. I do get some hypotension, but usually managable with LR and rarely need ephedrine. I like to use less drugs with a pregnant women until the cord is clamped. Then I give her Zofran, Decadron, ephedrine if necessary and Duramorph 3mg with 5 mL of NS in the epidural for pain mgmt. Toradol 30mg Iv/30 IM if not contraindicated. As a side note, Our docs take about 60 min open to close for a section. Slow, but that's what it takes.

I'd like to hear what other people are using so I can update or try new things. We all want "best" practice. What say you?

[JoeCRNA]

Hello All! It's time for me to re-visit my practice (habit) of my doses and drugs of choice for laboring epidurals when a c-sec has been called.

Currently I use 5-10 mL of 2% lidocaine (with or without epi) with 5-10 mL of nesacaine to speed it up. I do get some hypotension, but usually managable with LR and rarely need ephedrine. I like to use less drugs with a pregnant women until the cord is clamped. Then I give her Zofran, Decadron, ephedrine if necessary and Duramorph 3mg with 5 mL of NS in the epidural for pain mgmt. Toradol 30mg Iv/30 IM if not contraindicated. As a side note, Our docs take about 60 min open to close for a section. Slow, but that's what it takes.

I'd like to hear what other people are using so I can update or try new things. We all want "best" practice. What say you?

I most frequently use 10-20cc 2% lido with epi, a little bicarb for speed, and 100 mcg of fentanyl to improve the quality of the block. If hypotension presents itself, I tend to reach for neo first and then ephedrine, if not responsive to the neo. I like the reduction in HR associated with the neo and can't remember the last time i had to switch to ephedrine.

After baby is out, I use decadron and zofran for pts with a hx of motionsickness or ponv. In the last year, I have reduced my duramorph dose from 2.5-3mg to 2-2.5mg depending on height, less than 60-61" gets 2mg > than gets 2.5. I switched and have found less pruritis and no change in pt comfort level.

Our OB's vary widely in their skill level and as a result they have an unfortunate department policy of no toradol. Our sections can range from 30min-150min, depending on who is holding the knife. As a result of this variation, my elective sections frequently get epidurals with certain surgeons. If I have to top off in the OR, I switch to 2% lido sans epi.

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

That was great! Thanks. I also find that my patients tend to have a bit of itching witht he Duramorph. I will try decreasing the dose as you noted. Thanks! =)