Timing
- Aim to provide labour analgesia within 30minutes of request (from midwife request)
- There are no ‘early’ or ‘late’ limits for when to perform regional anaesthesia in labour
- ODP to assist in room
- Case midwife should have the following ready:
- IV access
-
- CADD pump for patient/midwifery controlled epidural analgesia
- CADD pump tubing
- 100mcg Fentanyl ampoule
Regime
- CSE is commonly performed
- Default kit is Braun but Portex kit also available if requested from ODPs
- Suggested dose: 1ml 0.25% plain Marcaine plus 25mcg Fentanyl
- Epidural pump to be connected to patient end with a second witness
- Midwife controlled bolus
- 9mls bolus, lockout 15min (default setting on pump)
PCA
- Not routinely offered to patients
- Is an option in situations such as IUD, sickle cell crisis, post GA LSCS
- Pumps are the same as ones used in HH
- Labour ward PCA policy currently being reviewed
- Midwives are not trained to set up PCA – we will be asked to do so. Once set up – PCA patient MUST have one to one midwife