dosing thru the epidural needle

[Arch Guillotti]

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I agree I think the chances are low, but it still muddies the water for intrathecal testing. Doesn't mean I don't do it.

Disagree. Done properly a CSE dose should not affect intrathecal testing. If the catheter is subarachnoid there will be a dense surgical block. As Noy said, with a CSE the pt. should still be able to easily move the legs.

 

[Noyac]

Disagree. Done properly a CSE dose should not affect intrathecal testing. If the catheter is subarachnoid there will be a dense surgical block. As Noy said, with a CSE the pt. should still be able to easily move the legs.

I agree.

MTgas, you are just regurgitating old school dogma.

 

[Noyac]

It is because you are using hyperbaric marcaine in the sitting position and getting a saddle block - not adequate for contractions. Try using 1 cc isobaric 0.25 marcaine with a little bit of fentanyl and this will be much more effective than your hyperbaric.

Yes, you need to use isobaric.

 

[dhb]

It is because you are using hyperbaric marcaine in the sitting position and getting a saddle block - not adequate for contractions. Try using 1 cc isobaric 0.25 marcaine with a little bit of fentanyl and this will be much more effective than your hyperbaric.

Well that's why i dilute the marcaine 2 folds and i try to lay them down pretty quick. The thing is i've had some complain of pelvic pain and others of abdominal pain...

 

[pjl]

I use 20 mcg fentanyl (its easier to get from the nurses) and 1 cc isobaric bupiv. I don't think the problem is that the pts are farther along in labor in your case b/c we frequently get called when the pt is 7, 8 or even 9 cm as they decide they now want an epidural. Even if they are far along in labor the relief is almost instant and it lasts 1-1 1/2 hrs. The only problem with the cse is that later on when the cse dose has worn off and they are on the epidural infusion they occasionally think that the epidural has stopped working. In reality its just that the epidural is not quite as strong as the spinal dose. And they are further along in their labor.

This is the only reason I don't like CSE. The call 1-2 hours later on a high enough % of ladies that I prefer making them all suffer greatly through 1 additional contraction before the epidural kicks in. But I am a bit of a jerk.

 

[deleted162650]

This is the only reason I don't like CSE. The call 1-2 hours later on a high enough % of ladies

That just hasn't ben my experience. I get called less for CSE'd pts than those that got a CLE.

 

[Urzuz]

http://www.ncbi.nlm.nih.gov/m/pubmed/23400985/

"CONCLUSIONS: Compared with traditional epidural labor analgesia, CSE analgesia provided better first-stage analgesia despite fewer epidural top-up injections by an anesthesiologist."

 

[deleted162650]

http://www.ncbi.nlm.nih.gov/m/pubmed/23400985/

"CONCLUSIONS: Compared with traditional epidural labor analgesia, CSE analgesia provided better first-stage analgesia despite fewer epidural top-up injections by an anesthesiologist."

Those are the guys I trained with (very busy PP OB only practice - us residents were just guests there as a CA-3 elective), and that's the technique I continue to use. My own personal experience over the last 2 years in PP is very consistent with that study.

 

[Orin]

The real question is who is doing the blood patches for the PDPH?

 

[leaverus]

i almost always dose through the tuohy. Risky? No more so than anything else we do. And anectodotally I feel I see fewer one-sided blocks and get called less frequently for topups compared to when I was doing cse.