Epidural top-up
Oct 09, 2023![](https://kajabi-storefronts-production.kajabi-cdn.com/kajabi-storefronts-production/file-uploads/blogs/2147545446/images/e05864-ff4b-864f-bdf7-aef1f6df76a_Concept_Series_website_YouTube_Banner_.png)
What does the anaesthetic nurse need to know about an epidural top-up for caesarean section? π§
4 things:
1οΈβ£ What drugs do you need? π
The most common formulation for top up is 2% Lignocaine with adrenaline (ensure it is safe for epidural administration). It is also common to add fentanyl up to 100mcg. Some centres may differ from this!
2οΈβ£ What is Plan B? π
The risk of failed epidural top up is 10-20%, and your options will depend on how far through the procedure you are:
π Perform spinal or repeat epidural (if surgery has not started)
π Convert to GA (if surgery has started) *see our post on GA Caesar
π Supplement with IV drugs (if baby has been delivered)
4οΈβ£ Red flags for failed top up π©
π Poor functioning epidural prior to caesarean (you can ask the patient this!)
π Multiple boluses on labour ward (you can check the chart for this!)
π Urgent case
4οΈβ£Side effects of top up
π Local anaesthetic toxicity (rare)
π High block (see our post on high spinal)
π Tachycardia (due to adrenaline if catheter is intravenous)
π Shivering (common side effect of epidural)
The bottom line is that most epidural top ups work well, but your team should always be prepared for plan B! π
Build knowledge β
Improve safety β
Ref: https://resources.wfsahq.org/atotw/conversion-of-labour-epidural-analgesia-to-anaesthesia-for-caesarean-delivery/