CSE ANALGESIA FOR VAGINAL BREECH DELIVERY.

* Position the patient and prepare the back.
* Identify epidural space at L3-4, or L4-5, using a loss of resistance technique.
* Advance 24G, 120mm Sprotte needlethrough Tuohy needle until resistance is encountered at the needletip.
* Gently advance the Sprotte needleuntil a dural 'pop' is felt.
* Support the Sprotte needle whilebracing the dorsum of the let hand against the patient's back.
* Remove stilete gently to avoid displacement of Sprotte needle
* Inject local anaesthetic mixture (bupivacaine 0.25%, 0.5 ml + fentanyl 25 mcg + NaCI 0.9%, to 2 ml).
* Remove the Sprotte needle Thread approximately 5cms of catheter into the epidural space. Pre-injection of bupivacaine (0.03125%, 5ml) through the Tuohy needle(after removing the Sprotte needle will facilitate advancement of the epidural catheter.
* After taping the epidural catheter to the back rotate the patient onto her right side, to spread the local anaesthetic more evenly.
* Unles the patient proceeds rapidly to full dilatation and delivery commence a continuous epidural infusion.