Neuraxial Drug Card - Epidural Dosing Flashcards
Lance Carter, CAA
Bicarbonate
Bolus Dose
1mEq/10mL local anesthetic
Chloroprocaine (Nesacaine)
Bolus Dose
5mL 3% (150mg)
T4 Dose
10-20mL 3% (300-600mg)
Epidural Onset
Fastest
Ropivicaine (Naropin)
Bolus Dose
5-10mL 0.2% (10-20mg)
Infusion Rate
6-14mL/hr (0.2%)
Epidural Onset
10-15 minutes
Lidocaine (Xylocaine)
Bolus Dose
5mL 2% (100mg)
T4 Dose
10-20mL 2% (200-400mg)
Epidural Onset
Few minutes
Bupivicaine (Marcaine)
Bolus Dose
5-10mL (0.125%)
Infusion Rate
8-15mL/hr (0.125%)
Epidural Onset
10-15 minutes
Fentanyl
Bolus Dose
50mcg
Infusion Rate
1mcg/mL in infusion bag
Sufentanil
Bolus Dose
10-15mcg
Duramorph
2-4mg
Epinephrine
Infusion Rate
1-2mcg/mL in infusion bag
Which LA produces the fastest epidural onset for bolusing during an emergency C-section?
Chloroprocaine (usually 3%) because of pseudocholinesterase metabolism, and it has minimal drug transfer across the placenta
Which LA is “motor sparing” and longest acting?
Marcaine (usually diluted to 0.1-0.25%)
Which LA is most effective at blocking the larger sacral nerves?
Lidocaine (2% or 1.5% with Epi) and has fast onset
Of all the commonly used epidural LA, which one produces the highest degree of motor block?
Chloroprocaine (usually 3%), shortest duration, and contraindicated intrathecally
What is commonly used as the initial epidural test dose?
5mL dose of 1.5% lidocaine with 1:200,000 epi
“Beware of tingling in ears, numbness around mouth, racing heart rate, or legs suddenly go numb”
What rules out accidental IV injection? (3)
Absence of:
- Tachycardia
- Mouth/tongue numbness, or metallic taste in mouth
- Ringing in the ears
What rules out accidental intrathecal injection?
Gradual onset of numbness, if it were intrathecal it would be instant
What and how much is the normal epidural loading dose?
5mL of marcaine or ropivicaine right after the 5mL test dose is given
Are you willing to risk the sympathectomy for faster onset??
