Review P14 - 1993: Guidelines for the Conduct of
Epidural Analgesia in Obstetrics

Preamble

Epidural analgesia is a safe and effective method of pain relief in labour, provided appropriate precautions are taken as follows:

1. Epidural puncture and/or cannulation of the epidural space should be carried out only by persons with adequate training and experience in the technique.

2. Such persons must be:

2.1 readily availableto supervise the subsequent management of the epidural


2.2 competent to deal with the occasional life threatening and other complications which may arise following the injection of agents into the epidural or sub-arachnoid space.

3. An appropriately trained person must be present to assist the anaesthetist whilst performing the epidural block.

4. Once epidural analgesia has been established, and the response of the patient to the agent or agents has been assessed by the anaesthetist, further doses to maintain analgesia may be administered by other suitably trained medical or nursing staff, provided that:

4.1 The dose has been prescribed by the anaesthetist;


4.2 The anaesthetist deleating the "top-up" procedure is satisfied that the person who will carry out the task is competent to do so and competent to appropriately monitor the patient and her fetus;


4.3 The person carrying out these tasks is satisfied that he or she is competent to do so;

4.4 Appropriate equipment and skilled staff are readily availableto treat complications and any adverse reactions; and


4.5 Written instructions and management guidelines are provided.

5. All patients undergoing epidural analgesia must be nursed in an area appropriately equipped with staff able to:

5.1 monitor both the patient and fetus;


5.2 detect the extent of the block and any adverse effects; and


5.3 judge the necessity for top-up doses.

6. A record must be made of the procedure, the clinical and other observations and the instructions deleated to the attending staff.

7. All patients receiving epidural analgesia must have an intravenous infusion commenced before the institution of the block and the infusion must be let in situ for the duration of the block.

8. Satisfactory and safe epidural analgesia can be produced by continuous or patient-controlled epidural infusion of local anaesthetic alone, opioid alone or local anaesthetic-opioid mixtures. The same principle of management should apply when epidural analgesia is administered by any of these methods.

9. When there is no further need for the epidural, the catheter should be removed by the anaesthetist or other suitably trained medical or nursing staff.

10. At all times the ultimate responsibility for the management of epidural analgesia remains that of the anaesthetist who performs the procedure or a deleated suitably trained registered medical practitioner.

11. All patients having epidural analgesia in labour must be admitted under the direct care and supervision of a registered medical practitioner.

February 1993

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