Case 10: Epidural Analgesia for Labor – Watch Out
A 42-year-old female (85 kg 5 ft 8 in.) is requesting an epidural for labor pain. She is a para 3 and has had epidurals in the past without any problem. Previous medical history is noncontributory and she has had no surgeries. The epidural is inserted uneventfully. The patient is placed on a continuous epidural infusion of 0.2% ropivacaine at a rate of 8 mL/h with patient-controlled epidural analgesia (PCEA) bolus setting at 6 mL/30 min using an epidural pump (Painsmart IOD, model #360-1101, Curlin Medical, Huntington Beach, CA 92649). The pump is placed above her by about 10 in. (30 cm) and attached to an IV pole. This is usual procedure, so the staff does not have to bend down to change the settings. The patient delivers a healthy boy 2 h later. After the episiotomy repair, the pump is turned off. Thirty minutes later no motor block is present. The patient received a total of approximately 40 mL of ropivacaine. She is very satisfied with your epidural and thanks you profusely. As she has consented for a tubal ligation, the epidural catheter is left in situ but as, mentioned, the pump is turned off.