Further doses of local anaesthetic will generally be required before any significant clinical anaesthesia is elicited. This may be after the induction of general anaesthesia. Drug doses are covered separately but, in general, a much larger volume is required than with a spinal to achieve any given effect, e.g. 10-20 ml 0.25% or 0.5% bupivacaine in an adult. It is because of the potential effects of this size of dose that careful exclusion of subarachnoid or intravascular placement is important prior to using an epidural.
Further doses of local anaesthetic will generally be required before any significant clinical anaesthesia is elicited. This may be after the induction of general anaesthesia. Drug doses are covered separately but, in general, a much larger volume is required than with a spinal to achieve any given effect, e.g. 10-20 ml 0.25% or 0.5% bupivacaine in an adult. It is because of the potential effects of this size of dose that careful exclusion of subarachnoid or intravascular placement is important prior to using an epidural.
Monitoring
As with spinals, all routine modalities of monitoring should be continued.
Further doses of local anaesthetic will generally be required before any significant clinical anaesthesia is elicited. This may be after the induction of general anaesthesia. Drug doses are covered separately but, in general, a much larger volume is required than with a spinal to achieve any given effect, e.g. 10-20 ml 0.25% or 0.5% bupivacaine in an adult. It is because of the potential effects of this size of dose that careful exclusion of subarachnoid or intravascular placement is important prior to using an epidural.
Positioning
Epidural local anaesthetic spread is much less influenced by position than with spinals and may not be affected at all.
Further doses of local anaesthetic will generally be required before any significant clinical anaesthesia is elicited. This may be after the induction of general anaesthesia. Drug doses are covered separately but, in general, a much larger volume is required than with a spinal to achieve any given effect, e.g. 10-20 ml 0.25% or 0.5% bupivacaine in an adult. It is because of the potential effects of this size of dose that careful exclusion of subarachnoid or intravascular placement is important prior to using an epidural.
Testing adequacy of block
When an epidural is used as the sole means of surgical anaesthesia, e.g. in caesarean section, the same general rules apply for testing quality of block as for spinals. When, as is more common, it is used for intraoperative and postoperative analgesia in conjunction with a general anaesthetic, a more qualitative assessment is acceptable.