A basic bread and butter case, or is it? 25 year old female with prolonged labor now going to the O.R. for C Section. Labor Epidural has worked pretty well. CRNA doses Epidural with 20 cc of 2% lidocaine, HCO3 and epi 1:200,000. 7 minutes later block is still patchy. The patient weights 250 and is 5'1" but otherwise healthy. Normal labs for pregnant patient. normal vitals and baby is fine. Now what? Patient wants REGIONAL and asks to be awake. OB MD is fine with giving you 20-30 minutes to "do your thing" (Neuraxial Anesthesia).