Neuraxial Drug Card - Epidural Dosing

Question 1

Bicarbonate

Answer 1

Bolus Dose
1mEq/10mL local anesthetic

Question 2

Chloroprocaine (Nesacaine)

Answer 2

Bolus Dose
5mL 3% (150mg)

T4 Dose
10-20mL 3% (300-600mg)

Epidural Onset
Fastest

Question 3

Ropivicaine (Naropin)

Answer 3

Bolus Dose
5-10mL 0.2% (10-20mg)

Infusion Rate
6-14mL/hr (0.2%)

Epidural Onset
10-15 minutes

Question 4

Lidocaine (Xylocaine)

Answer 4

Bolus Dose
5mL 2% (100mg)

T4 Dose
10-20mL 2% (200-400mg)

Epidural Onset
Few minutes

Question 5

Bupivicaine (Marcaine)

Answer 5

Bolus Dose
5-10mL (0.125%)

Infusion Rate
8-15mL/hr (0.125%)

Epidural Onset
10-15 minutes

Question 6

Fentanyl

Answer 6

Bolus Dose
50mcg

Infusion Rate
1mcg/mL in infusion bag

Question 7

Sufentanil

Answer 7

Bolus Dose
10-15mcg

Question 8

Duramorph

Answer 8

2-4mg

Question 9

Epinephrine

Answer 9

Infusion Rate
1-2mcg/mL in infusion bag

Question 10

Which LA produces the fastest epidural onset for bolusing during an emergency C-section?

Answer 10

Chloroprocaine (usually 3%) because of pseudocholinesterase metabolism, and it has minimal drug transfer across the placenta

Question 11

Which LA is “motor sparing” and longest acting?

Answer 11

Marcaine (usually diluted to 0.1-0.25%)

Question 12

Which LA is most effective at blocking the larger sacral nerves?

Answer 12

Lidocaine (2% or 1.5% with Epi) and has fast onset

Question 13

Of all the commonly used epidural LA, which one produces the highest degree of motor block?

Answer 13

Chloroprocaine (usually 3%), shortest duration, and contraindicated intrathecally

Question 14

What is commonly used as the initial epidural test dose?

Answer 14

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”

Question 15

What rules out accidental IV injection? (3)

Answer 15

Absence of:

1. Tachycardia
2. Mouth/tongue numbness, or metallic taste in mouth
3. Ringing in the ears

Question 16

What rules out accidental intrathecal injection?

Answer 16

Gradual onset of numbness, if it were intrathecal it would be instant

Question 17

What and how much is the normal epidural loading dose?

Answer 17

5mL of marcaine or ropivicaine right after the 5mL test dose is given

Are you willing to risk the sympathectomy for faster onset??