REFERENCE · OBSTETRIC ANAESTHESIA
Epidurals at LWH
Reference for siting, managing, troubleshooting, and converting labour epidurals at LWH. Use alongside the LWH anaesthetic department handbook and intranet guidelines.
Referral
Information to include
Patient location
Room / bed
Labour status
Stage, progress, urgency
Maternal pathology
Any associated co-morbidities
Helpful questions on the call
Confirm readiness before you arrive
Gowned?
Is the patient in a gown?
Informed?
Have they read the epidural information cards / electronic information and options for labour analgesia?
Ready?
Does the patient have a cannula, IV fluids, and recent, appropriate bloods?
Relevant bloods are listed in the LWH anaesthetic department handbook and intranet guidelines.
Response standard
National standards
Max time to review
Face-to-face within 1 hour of request
Target
80% of patients seen within 30 minutes
Out of hours
24-hour anaesthetist availability for epidural labour analgesia
Consent — cornerstones
Verbal consent rests on three things
Cards
Epidural information cards
Education
Prior patient education
Transfer
Clear verbal information at the bedside
A QR code for 'Options for labour analgesia' is posted in every room.
What to explain
The procedure in plain language
Why
Local anaesthetic provides relief from pain
How
An epidural catheter delivers local anaesthetic to the nerves of the epidural space
Siting
Catheter is sited using an epidural needle
Skin
Local anaesthetic is used to numb the skin first
Asepsis
Performed under aseptic technique
Maintenance
Continued local anaesthetic via the epidural is required to maintain pain relief
Complications to emphasise
Always mention
High block
High block
Infection
Epidural infection
Haematoma
Epidural haematoma
PDPH
Post-dural puncture headache
Set expectations
What an epidural can — and can't — achieve
Continuous care
Siting is the first step. Labour analgesic management is continuous from then on.
Early re-site
Consider for epidurals with obvious, major issues with pain relief (see Review).
Related intranet guidelines
LWH Anaesthesia