What’s your CSE concoction for labor analgesia?

[acidbase1]

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I’ve been trying different things, presently I use:

- spinal = 1cc 0.25% (2.5mg) plus 10 mcg fentanyl
- Tuohy = 5cc 1/8th marcaine through needle
- Catheter = 3cc test dose 1.5% lido w epi
- set pump

This seems to work pretty well, been switching things up lately.

 

[narcotics999]

I don't do CSE anymore.

Residency: intrathecally: 15mcg fentanyl or 3cc from the bag
thread the catheter, aspirate, 3cc 1.5% lido test.
pump

Nowadays: Catheter, 3cc lido test dose, 2.5% bupi 5cc + 0.125% bupi 5cc, pump.
I know from the beginning epidural is working. Onset fast enough, stable bp

 

[Arch Guillotti]

I’ve been trying different things, presently I use:

- spinal = 1cc 0.25% (2.5mg) plus 10 mcg fentanyl
- Tuohy = 5cc 1/8th marcaine through needle
- Catheter = 3cc test dose 1.5% lido w epi
- set pump

This seems to work pretty well, been switching things up lately.

I have never understood why you dose through the needle and then "test" the cath. I realize it may be common but it never made complete sense to me.

 

[deleted162650]

CSE (98% of the time):
- 2.5mL of the 1/8th bupi + fent 2/mL (bag solution) intrathecal
- 3-4mL more of the bag solution through the cath

CLE (the other 2% of the time):
- all 5mL 1.5%lido + epi test dose through the cath
- the remaining 2-3 mL 1%lido I didn’t use for skin local through the cath

 

[dhb]

2.5mL of the 1/8th bupi + fent 2/mL (bag solution) intrathecal

proceed to c-section

 

[deleted162650]

Why? That’s a pretty modest dose. Much lower than what I hear others talk about on this board. Occasionally I’ll see a little fetal brady but it’s always brief and self limited.

 

[Noyac]

I have been mixing in the “DRY” CSE lately. I like it.
CSE: (dose, 1cc.25% marcaine and 20mcg fentanyl) 3cc TD thru catheter
-pros
Quick relief
I can get the hell out of dodge faster in the middle of the night
-cons
Pt gets so comfy so fast that they think on occasion that the epidural isn’t worked well enough hours later.
I don’t like the CSE in the early labor primip

 

[Twiggidy]

I have never understood why you dose through the needle and then "test" the cath. I realize it may be common but it never made complete sense to me.

Agree. I guess in their defense people think the catheter could go intrathecal despite the needle being epidural, so in essence you now have a spinal catheter. That's the only defense I can come up with.

 

[acidbase1]

Dose through the needle to get better spread (dilation of space) and decrease incidence of heme cath. I have many many more heme caths when threaded through dry needle

 

[deleted162650]

Dose through the needle to get better spread (dilation of space) and decrease incidence of heme cath. I have many many more heme caths when threaded through dry needle

Which cath are you using?

 

[deleted162650]

I have been mixing in the “DRY” CSE lately. I like it.

You mean “DPE”?

As in the, “Just the tip, just to see how it feels” technique?

 

[Twiggidy]

You mean “DPE”?

As in the, “Just the tip, just to see how it feels” technique?

 

[Noyac]

You mean “DPE”?

As in the, “Just the tip, just to see how it feels” technique?

Yes DPE. Couldn’t remember the name.

 

[deleted162650]

Yes DPE. Couldn’t remember the name.

What do you like about it? IMO it’s right up there with the more ret*rded techniques ever invented.

 

[narcotics999]

Dose through the needle to get better spread (dilation of space) and decrease incidence of heme cath. I have many many more heme caths when threaded through dry needle

Are you using the rigid plastic catheter? Once I used the metal spiral one (flex tip???), I never got a single bloody cath

 

[Noyac]

What do you like about it? IMO it’s right up there with the more ret*rded techniques ever invented.

Yeah I thought the same. It seems to set up nicely. I’ve only done two though so I am no expert.

 

[osumd]

What do you like about it? IMO it’s right up there with the more ret*rded techniques ever invented.

there are some decent studies out there showing:
-more rapid onset than straight epidural, with less fetal bradycardia than CSE
-lower incidence of unilateral block vs epidural
-more reliable sacral coverage than straight epidural
-similar incidence of PDPH as straight epidural

A Randomized Trial of Dural Puncture Epidural Technique... : Anesthesia & Analgesia
PMID: 18931227

 

[acidbase1]

Are you using the rigid plastic catheter? Once I used the metal spiral one (flex tip???), I never got a single bloody cath

Yeah it’s plastic, comes in the kit