Epidural Anesthesia for Cesarean Section

Administration Protocol

• The American Society of Anesthesiologists recommends administering the total dose of 20-30 mL in appropriate fractions over a period of 10 minutes, and verifying the sensory level every 5 minutes until no further extension is observed 1
• Vasopressors (phenylephrine or ephedrine) should be immediately available, as hypotension occurs in 61-63% of cases 1

Safety Considerations

• If suspected intrathecal catheter placement, never exceed the equivalent of 10 mg of bupivacaine (approximately 13 mg of ropivacaine) as a test dose to minimize the risk of total spinal anesthesia 2, 3
• Negative aspiration does not completely exclude intrathecal placement 2

Monitoring Requirements

• Non-invasive blood pressure monitoring every 5 minutes during the first 15 minutes 4
• Continuous fetal heart rate monitoring for 30 minutes after the initial dose 3, 4
• Regular assessment of sensory level, especially after bolus doses 4

Multimodal Analgesia

• The American Society of Anesthesiologists suggests not omitting multimodal analgesia (paracetamol and intraoperative NSAIDs after delivery) unless contraindicated, as this significantly improves postoperative pain control 1