EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT EPIDURALS
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.
Complications
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.
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Give IV fluid bolus.
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Start O2 at 10 liters/min via non-rebreather mask
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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.
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Call anesthesiologist and additional nursing personnel.
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Have suction, ambu bag and crash cart available.
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Support blood pressure with fluids and vasopressors.
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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.
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Obtain crash cart.
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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