Regional Anesthetics Used During Pregnancy

Question 1

Epidural anesthesia

Answer 1

type of regional or local anesthetic used to provide analgesia to the lower half of the body.

During labor or just before birth, the anesthesiologist may inject regional anesthetic agents or infuse them by catheter inserted into the epidural space

There are two basic types of epidurals commonly used

Regular epidural
a combination of narcotic and anesthesia is administered common narcotics used: fentanyl or morphine
common anesthetics: bupivancaine, chloroprocaine or lidocaine

Combined epidural (CSE) or "walking epidural"
an initial dose of narcotic, anesthetic (or combination or the two) is injected into the intrathecal area
allows more freedom of movement in bed
client can ask for an epidural if the initial intrathecal injection does not provide enough pain relief

These anesthetics usually block from T-10 to S-5
Typically epidurals can be given after the client is dilated to four centimeters; an epidural should not be given after full dilation (10 centimeters)

The woman must sign a written consent to this pain relief

Question 2

The anesthesiologist has primary responsibility for these anesthetics, but the nurse must know

Answer 2

The anesthetic agent used, and its effects and side effects The level of sensory and motor changes to expect
The woman’s allergies to medications used for procedure

Question 3

Nursing responsibilities

Answer 3

Before administration of the epidural:

take vital signs record fetal heart rate
encourage her to empty her bladder or insert an indwelling urinary catheter

Inform the woman that she must remain in bed, because she will not be able to walk safely

Help the woman to a sitting or lateral position

Explain that the epidural will reduce her pain perception and mobility

After administration of the epidural, monitor the client’s blood pressure and fetal heart rate every 5 minutes for 30 minutes

if the client remains stable, assess every 15 to 30 minutes

if hypotension, dizziness, headache or fetal bradycardia occur, turn the woman slightly to her side
the physician may elevate the head or foot of the bed, based on further assessments

the IV rate may be increased and oxygen may be administered

Question 4

Observe for signs of maternal respiratory distress or other serious side effects of epidural anesthesia

Answer 4

headache shivering backache nausea