Epidural Anesthesia (OB)

Epidural anesthesia (block) local anesthetic is administered and an

epidural catheter is inserted into the space between the spinal cord and outer
membrane of the spinal cord (epidural space).
The epidural catheter is placed on the spine at or below the level of waist. The
catheter is taped to secure and avoid dislodging it.
Epidural medications (local anesthetics) such as bupivacaine (Marcaine) or
lidocaine.
may be also delivered in combination with opioids or narcotics (fentanyl and
sufentanil ) in order to decrease the required dose of local anesthetic. This produces
pain relief with minimal effects.
These medications may be used in combination with epinephrine, fentanyl,
morphine, or clonidine to prolong the epidurals effect or to stabilize the mothers
blood pressure.
It is administered by periodic or continuous infusion and monitored by
anesthesiologist or nurse-anesthetist.

Indication: It provides pain relief during labor from below diaphragm to

mid-thighs.
Common side effects of epidural anesthesia: Shivering, nausea, backache
and hypotension.
Epidural can cause labor to slow down and make your contractions weaker.
Epidural medications can cause respiratory depression and decreased fetal heart
rate in newborns.

Adverse side effects: The most common complications occurring with

epidural analgesia are maternal hypotension and urinary retention in the
immediate time and postural puncture headache and transient backache as
delayed side effects. Spinal headache is due to leakage of spinal fluids.
If spinal headache persists: Blood patch is performed by the
anesthesiologist).
Advantage of Epidural anesthesia (block)
1. Provides superior pain relief during first and second stages of labor.
2. Facilitates patient cooperation during labor and delivery.
3. Provides anesthesia for episiotomy or forceps delivery.
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4. Allows extension of anesthesia for cesarean delivery.
5. Avoids use of opioid-induced due to maternal and neonatal respiratory
depression.

Required position: Assist client to arch clients back and remain still while lying
on your left side or sitting up.
You will be asked to arch your back and remain still while lying on your left side or
sitting up.

When to administer epidural anesthesia: During active labor has been

established and the patient has requested pain relief. When cervix is 4 to 8
cm dilated (Active phase of labor).
Most ideal to start epidural is when cervix is dilated between 4-5
cm.

Contraindications: if cervix is less than 4 cm, infection to the spine, hardware

along the spine, sepsis (blood infection), and coagulation problem or use of
blood thinners or rapid labor.
Severe complications: Maternal convulsion and shock
Maternal position during epidural anesthesia (block): Do not place client in
supine position due to compression of abdominal aorta and the inferior vena
cava (aortocaval compression). Maternal hypotension occurs during epidural
analgesia when client is in supine position.
Epidural site of entry: S2-4 nerve roots to maintain analgesia during this stage of
labor
Post epidural within the next few hours after the birth the lower half of the body
may still feel numb. Numbness to lower extremities is likely expected and will
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require client to be assisted with walking.

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