Epidural anesthesia entails threading a catheter into the epidural space to administer local
anesthetics. The epidural space is located between the dura mater and the vertebrae and is
a passageway for nerve roots leaving the spinal cord. The nerves are bathed in the
anesthetic, thus providing pain relief for the areas of the body they innervate.
Before you start:
 Physician order
 Patent IV, 500-1,000 ml fluid bolus at start of epidural
 Patient consent, patient teaching done
 Safety pause
 Knowledge of baseline vital signs
 Knowledge of fetal status per EFM
Initiation of epidural- nursing responsibilities
 Position patient on her side or sitting. Support the mother throughout procedure.
Continue fetal monitoring throughout procedure.
 Place blood pressure cuff on patient arm and pulse oximeter on finger.
 Safety pause
 Note maternal blood pressure and pulse rate before and after the test dose.
Ongoing assessment
 Monitor BP, pulse rate every 5 minutes throughout administration of anesthetic dose
and then regularly per institution protocol
 Continuous fetal monitoring
 Evaluate level of anesthesia.
 Avoid maternal hypotension with uterine displacement, preferably by turning patient
to left or right lying positions. Change maternal position every 30-60 minutes
 Evaluate level of pain relief using pain scale.
 Evaluate bladder status and empty with straight or Foley catheter as needed.
Hypotension- generally seen 10-20 minutes after injection. A systolic BP less than
100mm/HG or 20% decrease from preanesthesia levels.
Turn patient to side.
Give IV fluid bolus.
Start O2 at 10 liters/min via non-rebreather mask
Notify anesthesia
If vasopressors are needed, give 5-10 mg Ephedrine IV as ordered.
Observe for signs of fetal distress.
High spinal-profound motor and sensory block within 1-5 minutes of epidural injection.
Call anesthesiologist and additional nursing personnel.
Have suction, ambu bag and crash cart available.
Support blood pressure with fluids and vasopressors.
Observe for signs of fetal distress.
Intravascular injection of local anesthetic- signs include change in maternal heart rate,
maternal hypertension, dizziness, tinnitus, metallic taste, loss of consciousness
Call for help, anesthesiologist.
Obtain crash cart.
Monitor fetal heart rate, blood pressure, EKG
If convulsion occurs, support patient with resuscitative measures as necessaryCPR, incubation, medications.
Dermatome Levels
Assess dermatome levels
every hour
Alcohol swab
Compare to arm
Compare each side