Consent

Consent for the technique should follow appropriate discussion with the patient of the advantages and disadvantages of the technique, and of the alternatives. Some centres may have a policy of obtaining written consent, although this is not mandatory.

Intravenous access

This is mandatory and should be of sufficiently large bore to allow rapid infusion in case of significant hypotension.

Location

The procedure should take place in an appropriate environment. This will usually be within the operating suite (or delivery room for a labour epidural). This ensures that the necessary equipment, assistance and emergency help are readily to hand, as well as implying an appropriate degree of cleanliness.

Assistance

An experienced assistant is essential. This will usually be an operating department practitioner or anaesthetic nurse who should have been suitably trained. In maternity, a midwife may assist at placement of epidural for labour analgesia. Senior expertise should be available at an appropriately close distance.

Monitoring

It is sensible to use full routine monitoring (electrocardiograph, pulse oximetry and intermittent non-invasive blood pressure) during placement of all neuraxial blocks.

Drugs

As well as the drugs necessary to perform the block, the operator should have to hand appropriate drugs to deal promptly with the common and serious side effects associated with neuraxial blockade. These will usually include vasopressors and anticholinergic agents.