Labor Epidural Analgesia
Target level: T10-L1 (uterine contractions). Consider early placement in high-risk patients.
Loading Dose
Bupivacaine 0.125%10-15 mL
OR Ropivacaine 0.2%10-15 mL
+ Fentanyl50-100 mcg
Give in 5 mL increments with aspiration
Maintenance (PCEA)
SolutionBupiv 0.0625-0.1% + fentanyl 2 mcg/mL
Basal rate6-10 mL/hr
Bolus dose5-8 mL
Lockout10-15 min
Max/hr20-25 mL
Troubleshooting
Unilateral block:
Withdraw catheter 1-2 cm, re-dose. Consider replacing if persistent.
Patchy block:
Bolus with higher concentration (0.25% bupivacaine 5-10 mL)
Breakthrough pain:
Assess level, re-bolus, consider replacement if > 2 re-doses needed
Hypotension:50-100 mcg IV
Left uterine displacement, fluid bolus, phenylephrine